Journal of

Case Reports and Images in Medicine

 
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Case Report
 
Non-uremic calciphylaxis in alcoholic hepatitis
Talal Alnabelsi1, Ramzi Mulki1, Corrado Minimo2, Janani Rangaswami3
1MD, Resident, Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA.
2MD, Chief Anatomic Pathologist, Pathology, Einstein Medical Center, Philadelphia, PA, USA.
3MD Attending Physician, Nephrology, Einstein Medical Center, Philadelphia, PA, USA.

Article ID: 100023Z09TA2016
doi:10.5348/Z09-2016-23-CR-16

Address correspondence to:
Talal Alnabelsi
5501 Old York Road, Einstein Medical Center
Philadelphia, PA 19141

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How to cite this article:
Alnabelsi T, Mulki R, Minimo C, Rangaswami J. Non-uremic calciphylaxis in alcoholic hepatitis. J Case Rep Images Med 2016;2:67–72.


Abstract
Introduction: Calciphylaxis is a rare vasculopathic disorder associated with high morbidity and mortality. Its pathogenesis is poorly understood but likely involves a complex cascade of metabolic interactions culminating in abnormal calcium deposition in vascular and extravascular structures. Calciphylaxis is well documented in the uremic population. Some cases in literature are reported in non-uremic patients, six of which are in patients with alcoholic cirrhosis. Our case demonstrates calciphylaxis successfully treated with bisphosphonates in a patient with alcoholic hepatitis without cirrhosis or kidney disease.
Case Report: A 37-year-old Caucasian female was, recently hospitalized for alcoholic hepatitis, presented with a painful rash on the thighs. The patient underwent extensive evaluation which revealed an elevated calcium-phosphorus product and slightly abnormal liver function tests. She underwent a biopsy of the rash which revealed evidence of calciphylaxis. The patient underwent topical wound care along with an aggressive pain regimen. She also received intravenous bisphosphonate therapy. The patient was subsequently discharged and on a follow-up visit demonstrated almost complete resolution of her symptoms.
Conclusion: Calciphylaxis is a rare and life-threatening disorder of subcutaneous vascular calcification and necrosis. While reported in patients with chronic kidney disease, only few cases describe the occurrence of calciphylaxis in the presence of liver disease. The patient had evidence of alcoholic liver disease which was likely a culprit in the pathogenesis of this condition. Our case reports on a rare entity occurring in an unusual setting and illustrates the importance of perusing a tissue diagnosis.

Keywords: Alcoholic liver disease, Calciphylaxis, Hepatitis, Non-uremic


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Author Contributions
Talal Alnabelsi – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ramzi Mulki – Substantial contributions to conception and design, Critical revision of the article, Final approval of the version to be published
Corrado Minimo – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Janani Rangaswami – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Talal Alnabelsi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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