A Dialysis Patient with Uremic Tumoral Calcinosis: Treatment with Sodium Thiosulfate
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Abstract
Uremic tumoral calcinosis is a rare complication in patients receiving renal replacement therapy. The condition is associated with high serum calcium and phosphate causing a deposition of calcium mass in various joints in the body. Uremic tumoral calcinosis occurs more commonly among patients with prolonged dialysis vintage. The effect on the musculoskeletal system and the pain causes significant physical impairment and many patients may not be able to continue to work. An in-depth review of published literature suggests that most patients with uremic tumoral calcinosis do not respond to treatment including dietary modification, medications and the change in dialysis prescription. Here, we present a 29-year-old male who has been on maintenance hemodialysis for several years presenting with worsening multiple, nodular, painful, cutaneous swellings of the left shoulder joint over the past three years. The lesions were initially misdiagnosed with tophi that supposedly contained uric acid crystals. He was prescribed high dose of uric acid lowering agent, but the lesions continued to increase in size. Later, the diagnosis of uremic tumoral calcinosis was made based on history, physical examination, imaging, and a confirmation by tissue biopsy. He received multimodality treatment comprising of low dialysate calcium, non-calcium-based phosphate binder and intravenous sodium thiosulfate. After 6 months, the size of the lesions decreased by more than half. The pain also substantially improved in association with the improvement in quality of life.
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