Clinical mimickers of calciphylaxis: A retrospective study - 15/05/21

Doi : 10.1016/j.jaad.2021.03.035

Colleen K. Gabel, BS ^a, Amy E. Blum, BA, MA ^b, Josie François, BA ^b, Teja Chakrala, BS ^c, Allison S. Dobry, MD ^d, Anna Cristina Garza-Mayers, MD, PhD ^e, Lauren N. Ko, MD, MEd ^e, Emily D. Nguyen, MD ^a, Radhika Shah, MD, PharmD ^f, Jessica St. John, MD, MBA, MPH ^g, Sagar U. Nigwekar, MD, MMSc ^h, Daniela Kroshinsky, MD, MPH ^a,^⁎
^a Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
^b Harvard Medical School, Boston, Massachusetts
^c Narayana Medical College and Hospital, Nellore, India
^d Department of Dermatology, University of California, Irvine School of Medicine, Irvine, California
^e Department of Dermatology, Harvard Medical School, Boston, Massachusetts
^f Department of Dermatology, Robert Wood Johnson Medical School, New Brunswick, New Jersey
^g Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
^h Department of Nephrology, Massachusetts General Hospital, Boston, Massachusetts

^∗Correspondence to: Daniela Kroshinsky, MD, MPH, Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, 2nd Floor, Boston, MA 02114.Department of DermatologyMassachusetts General Hospital50 Staniford Street, 2nd FloorBostonMA02114

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Abstract

Background

Calciphylaxis is an ischemic vasculopathy with high morbidity and mortality. Early and accurate diagnosis is critical to management of calciphylaxis. Clinical mimickers may contribute to delayed or misdiagnosis.

Objective

To assess the rate and risk factors for misdiagnosis and to identify clinical mimickers of calciphylaxis.

Methods

A retrospective medical record review was conducted of patients with calciphylaxis at a large urban tertiary care hospital between 2006 and 2018.

Results

Of 119 patients diagnosed with calciphylaxis, 73.1% were initially misdiagnosed. Of patients not initially misdiagnosed, median time to diagnosis from initial presentation was 4.5 days (interquartile range, 1.0-23.3), compared to 33 days (interquartile range, 13.0-68.8) in patients who were initially misdiagnosed (P = .0002). The most common misdiagnoses were cellulitis (31.0%), unspecified skin infection (8.0%), and peripheral vascular disease (6.9%). Patients who were misdiagnosed frequently received at least 1 course of antibiotics. Patients with end-stage renal disease were less likely to be misdiagnosed than those without this disease (P = .001).

Limitations

Single-center, retrospective study.

Conclusions

Understanding the risk factors for misdiagnosis of calciphylaxis is an opportunity for further education concerning this rare disease.

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Key words : calciphylaxis, diagnosis, differential diagnosis, misdiagnoses, outcomes, risk factors

Abbreviations used : ESRD, IQR

Plan

	Authors Blum and François contributed equally to this work.
	Funding sources: None.
	IRB approval status: The study was approved by the Partners Health Institutional Review Board (IRB) #2008P001589.
	Reprints not available from the authors.