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A 52-year-old man with end-stage renal disease (ESRD) undergoing haemodialysis presented with systemic non-healing and painful skin ulceration (figure 1A,B). Two years previously, he was diagnosed with giant cell arteritis manifesting as gradual vision loss and headache, and subsequently treated with glucocorticoids. Although skin biopsy of ulcerative lesions revealed no evidence of vasculitis, we suspected cutaneous vasculitis and administered high-dose glucocorticoids. Against our expectations, the ulcers worsened. During reassessment, laboratory tests demonstrated hyperphosphataemia (2.3 mmol/L; normal, 0.80–1.45) and elevated serum parathyroid hormone levels. CT revealed a generalised vascular calcification. The final diagnosis was calcific uraemic arteriolopathy (CUA). There were no other organ involvements of CUA including the lungs, skeletal muscles, pancreas, brain, eyes or digestive tract except skin. Despite multi-interventional therapy, including sodium thiosulfate and cinacalcet, the ulcers progressed. Six months after admission, he died due to sepsis.
Contributors All authors contributed to the patient’s care. NA contributed to the conception of the work. NA and TK acquired the data of the patient, and all authors interpreted the data. NA drafted the manuscript. TK and SJ critically revised the article. All authors approved the final version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Written consent for publication was obtained from the parents of the patient.
Ethics approval The institutional Research Ethics Board did not require board review for a single case when the patient’s privacy is protected.
Provenance and peer review Not commissioned; externally peer reviewed.
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