Curious case of calciphylaxis leading to acute mitral regurgitation

BMJ Case Rep. 2014 Apr 30:2014:bcr2013201803. doi: 10.1136/bcr-2013-201803.

Abstract

Calciphylaxis is uncommon and typically seen in patients with end-stage renal disease. It has been defined as a vasculopathic disorder characterised by cutaneous ischaemia and necrosis due to calcification, intimal fibroplasia and thrombosis of pannicular arterioles. We present the case of a 74-year-old woman with chronic kidney disease stage III who developed calciphylaxis leading to mitral valve calcification, chordae tendineae rupture and acute mitral regurgitation. Although an alternative explanation can typically be found for non-uraemic calciphylaxis, her evaluation did not reveal any usual non-uraemic causes including elevated calcium-phosphorus product, hyperparathyroidism, or evidence of connective tissue disease. Her wounds improved with sodium thiosulfate, pamidronate, penicillin and hyperbaric oxygen therapies but she ultimately decompensated with the onset of acute mitral regurgitation attributed to rupture of a previously calcified chordae tendineae. This case highlights an unusual case of calciphylaxis without clear precipitant as well as a novel manifestation of the disease.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Biopsy, Needle
  • Calciphylaxis / drug therapy
  • Calciphylaxis / etiology*
  • Calciphylaxis / physiopathology
  • Catheterization, Central Venous
  • Chordae Tendineae / diagnostic imaging
  • Chordae Tendineae / pathology*
  • Disease Progression
  • Drug Therapy, Combination
  • Echocardiography, Doppler
  • Fatal Outcome
  • Female
  • Heart Rupture / diagnostic imaging*
  • Heart Rupture / drug therapy
  • Heart Rupture / physiopathology
  • Humans
  • Immunohistochemistry
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / therapy
  • Mitral Valve Insufficiency / diagnostic imaging
  • Mitral Valve Insufficiency / drug therapy
  • Mitral Valve Insufficiency / etiology*
  • Severity of Illness Index
  • Tomography, X-Ray Computed