Panniculitis calcificans M79.3

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Definition
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Painful secondary pannicultitis of the subcutaneous fatty tissue with calcium deposits, which is due to calciphylaxis.

Occurrence/Epidemiology
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Rarely and almost without exception in dialysis patients (prevalence approx. 1%); in individual cases in chronic alcohol abuse.

Etiopathogenesis
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Terminal renal failure, secondary or tertiary hyperparathyroidism; insufficient hemodialysis (exceeding the solubility limit for calcium and phosphate in the blood).

Localization
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Mainly occurring on the abdomen or the front of the thighs.

Clinical features
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Livedo, erythematous nodules, often necrotizing and progressive until the development of torpid ulcers; often superinfections; occasionally varicosis and acrocyanosis.

Laboratory
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Electrolytes, parathormone, calcitonin, vitamin D3 hormone.

Histology
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Detection of calcification in the adipose tissue lobules as well as in the septa of the adipose tissue. Frequent single cell necrosis, sometimes confluent to larger fat cysts with basophilic debris and calcification. Mediavercalcification and intimal hyperplasia of the small arterial vessels.

Diagnosis
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Difficult, because often overlaid by other clinical pictures. Laboratory, histology.

Differential diagnosis
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Therapy
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Treatment of the underlying disease, haemodialysis, if necessary necrosis removal and skin reconstruction

Progression/forecast
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Poor, despite treatment (mortality approx. 80%).

Diet/life habits
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Low phosphate diet.

Literature
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  1. Lim SP (2003) Calciphylaxis in a patient with alcoholic liver disease in the absence of renal failure. Clin Exp Dermatol 28: 34-36
  2. Milas M (2003) Calciphylaxis and nonhealing wounds: the role of the vascular surgeon in a multidisciplinary treatment. J Vasc Surgery 37: 501-507
  3. Schwarz G et al (2000) Calciphylaxis: ischemic tissue necrosis in chronic renal failure. dermatologist 51: 36-40

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020