A53-46 When Wounds Become Lethal: Calciphylaxis- Induced Septic Shock in a Young Patient With End-stage Renal Disease

Background Calciphylaxis is a rare, life-threatening complication of end-stage renal disease (ESRD), characterized by systemic medial calcification of small vessels leading to ischemic necrosis of the skin and subcutaneous tissues. The condition is associated with high mortality and poses significant diagnostic and therapeutic challenges, particularly in younger patients with multiple comorbidities. Case Presentation We present a 36-year-old African American woman with ESRD secondary to diabetic nephropathy, on thrice-weekly hemodialysis for 3 years. Her extensive medical history included diabetes mellitus, hypertension, obesity, obstructive sleep apnea on home oxygen, chronic anemia, asthma, major depressive disorder, schizoaffective disorder, left eye blindness, and prior endocarditis requiring bioprosthetic aortic valve replacement. She had poor adherence to dialysis, and presented to the emergency department with acute hypoxic hypercapnic respiratory failure due to volume overload. She required intubation and was initiated on urgent dialysis via femoral access.At the intensive care unit, she developed multiple pressure ulcers that progressed to necrotic, bullous skin lesions involving the breasts, buttocks, thighs, abdomen, and legs. These wounds became the primary source of persistent sepsis, with cultures positive for Acinetobacter baumannii, Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. Despite broad-spectrum antibiotics, vasopressors, and multiple catheter changes, she remained febrile with ongoing hemodynamic instability. A skin biopsy confirmed the diagnosis of calciphylaxis, revealing subcutaneous vascular calcification and occlusive vasculopathy. Management included intensified daily dialysis and initiation of cinacalcet for secondary hyperparathyroidism. However, cinacalcet was discontinued due to worsening hypocalcemia. Surgical consultation for diversion colostomy to reduce wound contamination was deferred due to her poor surgical candidacy. The patient’s condition deteriorated with refractory septic shock, rising lactate levels, metabolic acidosis, and encephalopathy. Despite aggressive critical care measures, she succumbed to multi-organ failure on hospital day 78. Discussion This case illustrates the diagnostic and therapeutic complexities of calciphylaxis in a young ESRD patient. It highlights the risk of life-threatening infections originating from calciphylaxis-induced ulcers and the difficulty of managing mineral metabolism in critically ill patients. Patient discussion regarding compliance to hemodialysis, follow-up appointments, and medications must be emphasized, especially in vulnerable populations such as younger age groups and patients with mental illness. Conclusion Calciphylaxis should be considered in ESRD patients with rapidly progressing skin lesions. Early diagnosis, infection control, and multidisciplinary management are essential, though prognosis remains poor in severe cases. This abstract is funded by: None