A 69-year-old man with type 2 diabetes mellitus, hypertension, hepatitis C cirrhosis, and end-stage kidney disease (ESKD) on peritoneal dialysis for 2.5 years presented with a painful black eschar on the glans penis for 6 days. His body mass index was 22.7 kg/m2. He had no history of warfarin use but was receiving a calcium-based phosphate binder. He developed dysuria and penile discharge. Physical examination revealed gangrene of the glans penis (Figure 1A) with plaques, scaling, and multiple intractable ulcers on the arms and legs, clinically consistent with cutaneous manifestations of calciphylaxis; however, skin biopsy was not performed.
Thammathiwat et al. (Fri,) studied this question.