Resolution of penile calciphylaxis in a high-risk dialysis patient with medical therapy and wound care

Penile calciphylaxis is a rare but life-threatening manifestation of calcific uraemic arteriolopathy, most often seen in patients with end-stage renal disease (ESRD) on dialysis. Its diagnosis is frequently delayed, and its presence carries a poor overall prognosis. Given its rarity, treatment strategies and their efficacy have been understudied and may include observation, medical therapy, radical surgery or hyperbaric oxygen therapy. In this case, we describe a patient with ESRD presenting with a rapidly progressive penile lesion ultimately diagnosed as penile calciphylaxis. Our patient was ineligible for hyperbaric oxygen therapy and declined surgical management. Consequently, unlike many reported cases requiring surgical management nonetheless resulting in poor outcomes, our patient experienced lesional resolution with conservative therapy, specifically intravenous sodium thiosulfate and structured wound care with medical-grade honey, within 9 months after presentation. This case highlights a novel non-surgical approach to a difficult clinical situation and shows the potential efficacy and novelty of non-surgical management in select patients where penile calciphylaxis is diagnosed early in its course.