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Penile calciphylaxis in a patient with concurrent haemodialysis and Coumadin treatment
  1. Omar Jarrett1,2,
  2. Hamed Heydari1,3,
  3. Zachary Elder1,3 and
  4. Damian Casadesus1
  1. 1Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
  2. 2Internal Medicine, St George's University, Great River, New York, USA
  3. 3Internal Medicine, American University of the Caribbean School of Medicine BV, Plantation, Florida, USA
  1. Correspondence to Dr Damian Casadesus; dcasadesus{at}


A man in his 30s, with a medical history of end-stage renal disease on haemodialysis three times a week after kidney transplant rejection, anaemia of inflammatory disease, hypertension, atrial fibrillation, hyperlipidaemia, subtotal parathyroidectomy and aortic valve replacement on Coumadin treatment, presented to our institution with glans penis pain. Examination of the penis revealed a painful black eschar with ulceration on the glans penis with surrounding erythema. CT scan of the abdomen and pelvis and penile Doppler ultrasound revealed calcifications of the abdominal, pelvic and penile blood vessels. He was diagnosed with penile calciphylaxis, a very rare manifestation of calciphylaxis characterised by penile blood vessel calcification leading to occlusion, ischaemia and necrosis. Treatment with low calcium dialysate and sodium thiosulfate was initiated with haemodialysis. Five days after the treatment started, the patient’s symptoms improved.

  • Dermatology
  • Ultrasonography
  • Chronic renal failure
  • Radiology
  • Drugs misuse (including addiction)

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  • Contributors OJ, HH, ZE and DC participated in the clinical management of the patient. DC obtained and edited the picture. OJ, HH and ZE have been involved in the drafting and discussion of the manuscript. OJ, HH, ZE and DC reviewed and approved the final version. Dr Napat Rangsipat participated in the patient care, editing the pictures and the drafting and discussion of the manuscript and should be considered an author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.