Calciphylaxis induced by warfarin therapy in a patient with anti-phospholipid antibody syndrome associated with systemic lupus erythematosus

CEN Case Reports
Yasuyuki ShinozakiTakashi Wada

Abstract

Calciphylaxis is a life-threatening complication of end-stage kidney disease (ESKD) and leads to cutaneous necrosis and gangrene. Various risk factors for calciphylaxis have been reported, and warfarin therapy is a particularly strong trigger. Here we report the case of 50-year-old woman with ESKD and systemic lupus erythematosus who developed calciphylaxis after anti-thrombotic therapy, including warfarin, for ischemic skin ulcers due to arteriosclerosis obliterans and anti-phospholipid antibody syndrome. Although warfarin improved the thrombotic skin ulcers, it might also be a trigger for calciphylaxis. Discontinuation of the warfarin and the addition of low-density lipoprotein apheresis and sodium thiosulfate infusion failed to improve the gangrene; eventually, her legs had to be amputated to prevent lethal infection. The histology of the dermal and soft tissue obtained from the amputated legs showed typical findings of calciphylaxis. Warfarin is a vitamin K antagonist with inhibitory effects on the calcification of regulatory proteins, such as matrix Gla protein and fetuin-A. Therefore, the warfarin therapy might have induced calciphylaxis in our patient.

References

Mar 2, 2006·JAMA : the Journal of the American Medical Association·Wendy LimJohn W Eikelboom
Jul 20, 2010·Seminars in Dialysis·Melvin R Hayden, David J A Goldsmith
Aug 19, 2010·Oxidative Medicine and Cellular Longevity·Kurt M Sowers, Melvin R Hayden
Jul 12, 2011·Inflammation Research : Official Journal of the European Histamine Research Society ... [et Al.]·Wojciech PlazakPiotr Podolec
Nov 29, 2011·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Matsuhiko HayashiUNKNOWN Japanese Calciphylaxis Study Group
Jan 8, 2013·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Emanuel ZittKarl Lhotta

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Antiphospholipid Syndrome

Antiphospholipid syndrome or antiphospholipid antibody syndrome (APS or APLS), is an autoimmune, hypercoagulable state caused by the presence of antibodies directed against phospholipids.

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