Rationale: Nephritis can further develop into chronic kidney disease (CKD). CKD with calciphylaxis is mainly manifested as necrotic ulcers of terminal tissues or even gangrene in the skin and distal limbs. Patients with CKD have a high risk of developing multidrug-resistant bacterial infections. Patient concerns: Our patient developed dry gangrene of both feet for 1 month, accompanied by complications, such as anemia, hypoproteinemia, and pulmonary infection. The patient had a history of CKD for 30 years, calciphylaxis for 5 years, and multidrug-resistant bacterial infection for 1 month. Diagnoses: The patient was diagnosed with atherosclerotic gangrene of the lower extremities (dry gangrene of both feet), multidrug-resistant bacterial infection, pulmonary infection, hypoalbuminemia, anemia (moderate), urinary tract infection, and CKD with calciphylaxis. Interventions: In this case, the patient underwent a clinical evaluation and was successfully resuscitated. After achieving clinical cure criteria for multidrug-resistant bacterial infection, the patient underwent a mid-calf amputation of both legs under general anesthesia. Half a year post-operation, due to a recurrence of multidrug-resistant bacterial infection, the stumps of the amputated legs ulcerated with bone exposure. While treating multidrug-resistant infection, the patient was pharmacologically treated for CKD. In addition, debridement of the infected wounds and reamputation of both leg stumps were performed. Outcomes: Following the reamputation surgery, the patient underwent stump training for 3 months, and then walked on ground with prostheses. Lessons: Reflections prompted by this case: a textbook approach to treatment (standardized, systematic treatment strategy) is crucial. In this case, the primary objective was to save the patient’s life, concurrently alleviating symptoms such as anemia and hypoproteinemia, rigorously combating multidrug-resistant bacterial infection, and performing a mid-calf amputation of both legs. Six months after operation, the recurrence of multidrug-resistant bacterial infection resulted in bone exposure at the stumps of both legs, and the patient had to undergo reamputation of both leg stumps.
Zhao et al. (Fri,) studied this question.