Case Report/Case Series |

Intralesional Sodium Thiosulfate for the Treatment of Calciphylaxis

Lauren Strazzula, BA1; Sagar U. Nigwekar, MD2; David Steele, MD2; William Tsiaras, MD, PhD1; Meghan Sise, MD3; Sabina Bis, MD1; Gideon P. Smith, MD, PhD1; Daniela Kroshinsky, MD, MPH1
[+] Author Affiliations
1Department of Dermatology, Massachusetts General Hospital, Boston
2Department of Nephrology, Massachusetts General Hospital, Boston
3Department of Internal Medicine, Massachusetts General Hospital, Boston
JAMA Dermatol. 2013;149(8):946-949. doi:10.1001/jamadermatol.2013.4565.
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Importance  Calciphylaxis is a potentially fatal disorder of abnormal calcium deposition. Patients commonly present with painful retiform to stellate purpuric lesions that often undergo ulceration and necrosis, increasing the risk of infection and life-threatening sepsis. Treatment is multifaceted, and improved outcomes have been demonstrated with intravenous sodium thiosulfate; however, the use of this medication can be limited by its adverse effects. The use of topical sodium thiosulfate has been successfully reported for superficial calcium deposits in the skin from other processes. Therefore, we hypothesized that intralesional (IL) sodium thiosulfate may be an effective treatment for the deeper lesions of cutaneous calciphylaxis. We provide a retrospective case review of 4 patients with calciphylaxis who were treated with IL sodium thiosulfate.

Observations  Four patients with biopsy-proven cutaneous calciphylaxis were treated with IL sodium thiosulfate (250 mg/mL) in areas of clinically active disease. The patients tolerated the medication well, with only transient localized discomfort during injection. All 4 patients had complete healing of their ulcers and remission of disease.

Conclusions and Relevance  Intralesional sodium thiosulfate may be an effective and well-tolerated treatment for localized calciphylaxis. This novel approach requires further research and investigation.

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Figure 1.
Clinical Photographs of Patient 1’s Left Leg

A, Large ulceration on the posterior aspect of the leg extends circumferentially, with surrounding purpura indicating active disease. B, As the ulcer gradually decreased in size, remaining areas of purpura were injected with sodium thiosulfate. C, At 12 weeks, the ulcer was nearly healed, with no signs of active disease. D, Six months after presentation, the ulcerations had healed.

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Figure 2.
Clinical Photographs of the Medial Aspect of Patient 4’s Right Thigh

A, Cutaneous necrosis with overlying dry eschar and surrounding purpura. B, Twenty weeks after presentation, the ulcer was completely healed.

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