Sodium thiosulfate (STS) is known as an antidote in cyanide intoxication and has recently been used for treating calciphylaxis. Treatment so far includes optimum phosphate and calcium control, treatment of hyperparathyroidism, extensive dialysis and hyperbaric oxygenation. However, a biopsy is frequently avoided as it may trigger skin necrosis. The diagnosis is mainly made clinically and can be confirmed by skin biopsy. The risk factors for calciphylaxis include end-stage renal disease (ESRD), dialysis treatment, hyperphosphatemia, hypercalcemia, hyperparathyroidism, diabetes mellitus and female gender. The literature on STS treatment for calciphylaxis in dialysis patients was also reviewed.Ĭalciphylaxis is a rare but life-threatening disease. Our case demonstrates that STS treatment did not work through normalizing calcium-phosphorus profiles, although to optimize hyperparathyroidism and to control calcium and phosphorus levels is clearly part of the general treatment of calciphylaxis. STS, as a chelating agent for calcium and iron, is an emerging treatment option for calciphylaxis however, the mechanisms of STS in treating calciphylaxis are not clear. Until now, no recurrence of calciphylaxis has been observed during the more than 7 years of follow-up.

Total parathyroidectomy was carried out 6 months after the STS therapy, which successfully solved hyperparathyroidism and the high calcium-phosphorus profiles. The painful skin ulcers improved significantly soon after treatment, with a slight reduction in the calcium-phosphorus product. Sodium thiosulfate (STS) was used for treatment in this case.

We report a case with calciphylaxis and severe secondary hyperparathyroidism. Calciphylaxis is a rare but life-threatening complication seen in dialysis patients.

Sodium thiosulfate antidote