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Calciphylaxis induced by warfarin therapy in a patient with anti-phospholipid
antibody syndrome associated with systemic lupus erythematosus
#MMPMID28509094
Shinozaki Y
; Furuichi K
; Sagara A
; Kitajima S
; Toyama T
; Hara A
; Iwata Y
; Sakai N
; Shimizu M
; Kaneko S
; Wada T
CEN Case Rep
2015[Nov]; 4
(2
): 169-173
PMID28509094
show ga
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.
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