Calciphylaxis in a morbidly obese woman with rheumatoid arthritis presenting with severe weight loss and vitamin D deficiency.

OBJECTIVE:
To present an unusual case of calciphylaxis in an obese patient with inactive rheumatoid arthritisRheumatoid arthritisAutoimmune synovitis characterized by the presence of anticitrullinated protein Abs, although the exact targets and role of anticitrullinated protein autoimmunity in the pathogenesis of RA remain to be defined and normal renal function.

METHODS:
We describe a 46-year-old morbidly obese Caucasian woman who had previously weighed 200 kg and presented with painful leg ulcers following a rapid weight loss of 102 kg in 1 year.

RESULTS:
The subject was admitted with a 6-week history of painful leg ulcers that progressed to her thighs. Vasculitis and active rheumatoid arthritisRheumatoid arthritisAutoimmune synovitis characterized by the presence of anticitrullinated protein Abs, although the exact targets and role of anticitrullinated protein autoimmunity in the pathogenesis of RA remain to be defined were excluded clinically and biochemically. A skin biopsy confirmed calciphylaxis in the context of normal renal function. Serum 25-hydroxyvitamin D was low at 14 ng/mL (reference range, 20 to 200 ng/mL), with an elevated serum parathyroid hormone level of 241 pg/mL (reference range, 10 to 65 pg/mL), but normal serum calcium and phosphorus levels. The skin lesions persisted despite local wound care, daily hyperbaric oxygen, and parenteral sodium thiosulfate therapies. After normalizing the serum vitamin D level through oral supplementation, she responded well to pamidronate infusion with complete healing of the ulcers and regained 13% of her premorbid weight.

CONCLUSION:
This is the first case of calciphylaxis preceded by weight loss of greater than 100 kg in a patient with hypovitaminosis D who responded to pamidronate therapy.

Published In:

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists • 2011 Jul-Aug

Authors & Affiliation:

Malabu, Usman H; Roberts, Lynden J; Sangla, Kunwarjit S
Department of Endocrinology and Diabetes, The Townsville Hospital, Douglas, Australia. umalabu@yahoo.com

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Terminology Definitions on this Page

What's This?Terminology definitions come from medical journal articles which appear in this category.

Rheumatoid arthritis (RA)
Autoimmune synovitis characterized by the presence of anticitrullinated protein Abs, although the exact targets and role of anticitrullinated protein autoimmunity in the pathogenesis of RA remain to be defined

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