Abstract and Introduction
Introduction: Calciphylaxis is a rare, highly morbid pathological syndrome of vascular calcification and tissue necrosis. It is predominantly seen in patients with end-stage renal disease (ESRD) on chronic dialysis. There is no definitive standard of care for calciphylaxis, and the overall prognosis for patients, particularly those with ulcerated lesions, is bleak. One important role of wound care clinicians during the COVID-19 pandemic is to ensure that the continuity of care of an at-risk population is maintained while limiting the patient's potential exposure to the virus. Innovative therapies paired with alternative treatment sites of service are one such method.
Case Report: A 56-year-old female with ESRD on at-home peritoneal dialysis (PD) presented to the outpatient wound clinic with a punch biopsy-proven calciphylaxis lesion. Within days, state-wide "shelter-at-home" orders due to the COVID-19 pandemic went into effect. To prevent disruption in care and to minimize risk to the patient, the lesion was treated with bi-weekly self-application of a continuous topical oxygen therapy (cTOT) device paired with weekly telemedicine visits. The wound completely resolved after 9 weeks of topical oxygen therapy with no complications or device malfunctions.
Conclusions: This case, to the authors' knowledge, is the first to document healing in a calciphylaxis wound with the use of cTOT. Topical oxygen therapy may be a beneficial adjunctive therapy in the treatment of wounds caused by calciphylaxis. Finding creative ways to navigate this current health care crisis is essential to help mitigate risk for vulnerable patients with advanced comorbidities.
Most modern-day health care professionals in the United States practice medicine in ideal conditions, with the assumption that resources and supplies are ample and readily available. The COVID-19 viral pandemic challenges this assumption not just in the United States but around the world. Patients with chronic illnesses (eg, diabetes, hypertension, and obesity) are at an increased risk of morbidity and mortality from COVID-19.[1–4] The implication of this increased risk for patients with hard-to-heal wounds who frequently suffer from such comorbidities is dire.
The important role of wound care clinicians during this pandemic is to ensure that the continuity of care of an at-risk population is maintained while limiting the patient's potential exposure to SARS-CoV-19—the virus that causes COVID-19. Vigilance in keeping wound care patients free from hospital admissions permits hospital beds to remain open for severely ill patients with COVID-19. In doing so, determining who needs to be seen in person, and who can safely remain at home for treatment, has implications for the patient, the health of medical workers, and the public.
Herein, the authors present a case of a biopsy-proven calciphylaxis lesion in a patient with end-stage renal disease (ESRD) that was successfully treated with a self-application of a continuous topical oxygen therapy (cTOT) device paired with telemedicine visits. This regimen allowed for continued care and uncomplicated healing while mitigating the potential exposure to SARS-CoV-19 that the patient may have experienced had she attended weekly outpatient clinic visits. This case, to the authors' knowledge, is the first to document healing in a calciphylaxis wound with the use of cTOT.
Wounds. 2020;32(11):294-298. © 2020 HMP Communications, LLC