Atypical Presentation of Calciphylaxis in an African American Male with End-Stage Renal Disease

Background Calciphylaxis is a life-threatening vascular calcification disorder most commonly seen in patients with end-stage renal disease. Diagnosis is often delayed when classic cutaneous findings are absent. Objective To describe an atypical presentation of calciphylaxis requiring histopathologic confirmation and conservative multidisciplinary management. Methods Clinical evaluation, laboratory assessment, histopathologic examination, and multidisciplinary management were performed. Results A 67-year-old African American man with dialysis-dependent end-stage renal disease presented with localized pain from a persistent scabbed plaque on the left shin. Examination revealed tender indurated plaques without ulceration or violaceous discoloration. Laboratory studies demonstrated hyperphosphatemia, elevated calcium–phosphorus product, and markedly increased parathyroid hormone levels. Punch biopsy showed subcutaneous calcification with fat necrosis and foreign body giant cell reaction, confirming calciphylaxis. Wound cultures grew methicillin-susceptible Staphylococcus aureus and were treated with antibiotics. Due to hemodynamic fragility, management was conservative and included pain control, topical therapy, and specialized wound care. Dialysis intensification and sodium thiosulfate were avoided. The lesion gradually re-epithelialized. The patient later died from unrelated comorbidities. Conclusions Calciphylaxis may present without classic cutaneous findings, delaying recognition. Histopathology is essential for diagnosis in atypical cases, and conservative multidisciplinary care may be appropriate for medically fragile patients.