Nonuremic Calciphylaxis: A Rare and Unexpected Diagnosis of Necrotic Ulcers.

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.

Buschke-Ollendorff syndrome: a 32-month-old boy with elastomas and craniosynostosis.

A 32-month-old boy with hypotonia, developmental delay, and multiple craniofacial abnormalities including craniosynostosis presented with numerous nonspecific, flesh-colored papules on his right flank. Upon biopsy, these lesions were diagnosed as elastomas. Similar skin lesions were found in the patient's younger brother. The patient's father and brother had osteopoikilotic lesions on radiography, but the patient did not have these findings. None of the reported cases to date have included craniosynostosis in association with Buschke-Ollendorff syndrome. In addition to the case findings, the report also provides a short and current review of the syndrome.