{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:56Z","timestamp":1783509296051,"version":"3.55.0"},"reference-count":13,"publisher":"MDPI AG","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>Calciphylaxis is a rare and devastating condition found almost exclusively in patients with end-stage renal disease. Nonuremic calciphylaxis, an even more rare diagnosis, occurs in patients with preserved kidney function. We present a fatal case of nonuremic calciphylaxis with delayed and unexpected diagnosis despite early biopsy and testing. The patient presented with a 2-month history of painful ulceration to the left leg. Early biopsy was negative for calciphylaxis. Laboratory tests were negative for renal disease and autoimmune disorders. There was elevated parathyroid hormone (96 pg\/mL) 3 months after initial presentation and documented cobalamin deficiency. The patient went on to develop wounds to both legs and her thighs. A second biopsy of a left thigh wound by means of the dermatology service revealed calciphylaxis. The purpose of this case report is to raise awareness of calciphylaxis as a differential diagnosis for chronic necrotic skin ulcers, especially in patients with preserved renal function and those on warfarin therapy.<\/jats:p>","DOI":"10.7547\/21-174","type":"journal-article","created":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T12:30:40Z","timestamp":1709555440000},"source":"Crossref","is-referenced-by-count":1,"title":["Nonuremic Calciphylaxis: A Rare and Unexpected Diagnosis of Necrotic Ulcers"],"prefix":"10.3390","volume":"114","author":[{"given":"Beth B.","family":"Richardson","sequence":"first","affiliation":[{"name":"UW Health, Rockford, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Stees","sequence":"additional","affiliation":[{"name":"Community General Hospital Medical Center, Sterling, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon R.","family":"Gumbiner","sequence":"additional","affiliation":[{"name":"Katherine Shaw Bethea Hospital, Dixon, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"Curr Drug Saf","first-page":"246","article-title":"Non-uremic calciphylaxis: a rare and late adverse reaction to warfarin","volume":"14","author":"Patel DM","year":"2019","unstructured":"Patel DM, Patel MV, Patel AD, et al: Non-uremic calciphylaxis: a rare and late adverse reaction to warfarin. Curr Drug Saf 14: 246, 2019."},{"key":"B2","series-title":"J Am Coll Clin Wound Spec","first-page":"24","article-title":"Calciphylaxis in patients with preserved kidney function","volume":"6","author":"Maroz N","year":"2015","unstructured":"Maroz N, Mohandes S, Field H, et al: Calciphylaxis in patients with preserved kidney function. J Am Coll Clin Wound Spec 6: 24 2015."},{"key":"B3","series-title":"JAMA Dermatol","first-page":"309","article-title":"Warfarin-associated nonuremic calciphylaxis","volume":"153","author":"Yu WH","year":"2017","unstructured":"Yu WH, Bhutani T, Kornik R, et al: Warfarin-associated nonuremic calciphylaxis. JAMA Dermatol 153: 309, 2017."},{"key":"B4","series-title":"Eur J Case Rep Intern Med","first-page":"000986","article-title":"Non-uremic calciphylaxis: a rare diagnosis with limited therapeutic strategies","volume":"5","author":"Gomes F","year":"2018","unstructured":"Gomes F, La Feria P, Costa C, et al: Non-uremic calciphylaxis: a rare diagnosis with limited therapeutic strategies. Eur J Case Rep Intern Med 5: 000986, 2018."},{"key":"B5","series-title":"Dtsch Arztebl Int","first-page":"265","article-title":"Non-uremic calciphylaxis","volume":"115","author":"Holtsche MM","year":"2018","unstructured":"Holtsche MM, Zillikens D, Shimanovich I Non-uremic calciphylaxis. Dtsch Arztebl Int 115: 265, 2018."},{"key":"B6","series-title":"Am J Kidney Dis","first-page":"133","article-title":"Calciphylaxis: risk factors, diagnosis, and treatment","volume":"66","author":"Nigwekar SU","year":"2015","unstructured":"Nigwekar SU, Kroshinksy D, Nazarian RM, et al: Calciphylaxis: risk factors, diagnosis, and treatment. Am J Kidney Dis 66: 133, 2015."},{"key":"B7","series-title":"N Engl J Med","first-page":"1704","article-title":"Calciphylaxis","volume":"378","author":"Nigwekar SU","year":"2018","unstructured":"Nigwekar SU, Thadhani R, Brandenburg VM: Calciphylaxis. N Engl J Med 378: 1704, 2018."},{"key":"B8","series-title":"J Am Coll Clin Wound Spec","first-page":"2","article-title":"Wound healing in patients with impaired kidney function","volume":"5","author":"Maroz N","year":"2014","unstructured":"Maroz N, Simman R: Wound healing in patients with impaired kidney function. J Am Coll Clin Wound Spec 5: 2, 2014."},{"key":"B9","series-title":"Clin Med (Lond)","first-page":"594","article-title":"Lesson of the month 2: non-uraemic calciphylaxis\u2014an unexpected differential diagnosis for a necrotic ulcer","volume":"15","author":"Bataillard EJ","year":"2015","unstructured":"Bataillard EJ, Clayton J, Riordan J, et al: Lesson of the month 2: non-uraemic calciphylaxis\u2014an unexpected differential diagnosis for a necrotic ulcer. Clin Med (Lond) 15: 594, 2015."},{"key":"B10","series-title":"Int J Gen Med","first-page":"665","article-title":"Warfarin-induced calciphylaxis: a case report and review of literature","volume":"6","author":"Saifan C","year":"2013","unstructured":"Saifan C, Saad M, El-Charabaty E, et al: Warfarin-induced calciphylaxis: a case report and review of literature. Int J Gen Med 6: 665, 2013."},{"key":"B11","series-title":"J Cell Biol","first-page":"1971","article-title":"Participation of endothelial cells in the protein C-protein S anticoagulant pathway: the synthesis and release of protein S","volume":"102","author":"Stern D","year":"1986","unstructured":"Stern D, Brett J, Harris K, et al: Participation of endothelial cells in the protein C-protein S anticoagulant pathway: the synthesis and release of protein S. J Cell Biol 102: 1971, 1986."},{"key":"B12","series-title":"Nephrol Dial Transplant","first-page":"2176","article-title":"Hyperbaric oxygen in the treatment of calciphylaxis: a case series","volume":"16","author":"Podymov T","year":"2001","unstructured":"Podymov T, Wherrett C, Burns KD: Hyperbaric oxygen in the treatment of calciphylaxis: a case series. Nephrol Dial Transplant 16: 2176, 2001."},{"key":"B13","series-title":"Clin J Am Soc Nephrol","first-page":"1139","article-title":"Calciphylaxis from nonuremic causes: a systematic review","volume":"3","author":"Nigwekar SU","year":"2008","unstructured":"Nigwekar SU, Wolf M, Stems RH, et al: Calciphylaxis from nonuremic causes: a systematic review. Clin J Am Soc Nephrol 3: 1139, 2008."}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/114\/1\/21-174.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/114\/1\/21-174.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/114\/1\/21-174.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:19:32Z","timestamp":1783505972000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/114\/1\/21174"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":13,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.7547\/21-174","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}