Fractures in calciphylaxis patients following intravenous sodium thiosulfate therapy

Abstract

Calciphylaxis is a highly fatal syndrome of small vessel calcification that results in skin ischemia and necrosis.[1] Affected patients present with extremely painful, violaceous skin lesions that progress to non-healing ulcers, and can be complicated by superimposed infections and sepsis.[2] The mortality rate from calciphylaxis is estimated at 60-80%.[2, 3] Sodium thiosulfate (STS), an increasingly popular treatment for calciphylaxis, is theorized to work through vasodilation, antioxidation, and calcium chelation. Known adverse effects include volume overload, metabolic acidosis, and hypotension.[2, 4] We report four patients who experienced unusual fractures during or following treatment with intravenous STS (IVSTS), an adverse effect that has not yet been reported in the literature.

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