A 58-year-old woman presented with multiple extensive, necrotic ulcers on the proximal lower limbs (Figure, A and B). A diagnosis of calciphylaxis in the absence of renal impairment was made. Although non-uraemic calciphylaxis has been described previously, the pathogenic mechanisms and significance of documented risk factors are poorly understood. Multiple risk factors were identified in this patient, of which the most prominent is likely to have been severe and longstanding hypoalbuminaemia of unexplained cause. In addition, obesity, European ancestry, female sex, hypovitaminosis D, an elevated alkaline phosphatase level, non-alcoholic steatohepatitis, weight loss and use of steroids were all features of this case that have documented associations with calciphylaxis.
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