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Research Letter |

The Role of Bone Scintigraphy in the Diagnosis of Calciphylaxis ONLINE FIRST

Suchismita Paul, MD1,2; Carlos A. Rabito, MD, PhD3; Priyanka Vedak, MD4; Sagar U. Nigwekar, MD, MMSc5; Daniela Kroshinsky, MD, MPH4
[+] Author Affiliations
1Medical student at Harvard Medical School, Boston, Massachusetts, at the time of the study
2now with Department of Medicine and Department of Dermatology and Cutaneous Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida
3Department of Radiology, Massachusetts General Hospital, Boston
4Department of Dermatology, Massachusetts General Hospital, Boston
5Department of Nephrology, Massachusetts General Hospital, Boston
JAMA Dermatol. Published online December 16, 2015. doi:10.1001/jamadermatol.2015.4591
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This case-control study assesses the use of bone scintigraphy to diagnose calciphylaxis in cases with the disease and in controls with end-stage renal disease without calciphylaxis.

Calciphylaxis is a rare, life-threatening small vessel vasculopathy,1 predominantly seen in patients with end-stage renal disease (ESRD). Most physicians rely on clinical findings and risk factors to diagnose calciphylaxis. However, mimickers exist,2 and tissue biopsy can be helpful to differentiate these diseases. Unfortunately, histopathological confirmation sometimes requires multiple biopsies, resulting in delayed treatment and possibly propagating new lesion formation.3 A noninvasive early testing modality would be preferred.

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Figure.
Patients With Calciphylaxis

The arrowheads indicate uptake of radiotracer. A, Bone scintigraphy of a patient with biopsy-proven calciphylaxis showing patchy uptake of the radiotracer throughout the body, including bilateral arms, chest wall, pelvis, buttocks, and medial thighs. B, Bone scintigraphy of another patient with biopsy-proven calciphylaxis, before treatment with sodium thiosulfate. The radiotracer uptake can be seen in the pelvis, medial thigh, and medial and lateral calf. C, Six months after treatment, bone scintigraphy in the same patient reveals minimal uptake in the medial calf.

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