Clinical mimickers of calciphylaxis: A retrospective study

Abstract

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. To assess the rate and risk factors for misdiagnosis and to identify clinical mimickers of calciphylaxis. A retrospective medical record review was conducted of patients with calciphylaxis at a large urban tertiary care hospital between 2006 and 2018. Of 119 patients diagnosed with calciphylaxis, 73.1% were initially misdiagnosed. Of patients not initially misdiagnosed, median time to diagnosis from initial presentation was 4.5days (interquartile range, 1.0-23.3), compared to 33days (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). Single-center, retrospective study. Understanding the risk factors for misdiagnosis of calciphylaxis is an opportunity for further education concerning this rare disease.