Images in Nephrology (Section Editor: G. H. Neild) Severe systemic calciphylaxis with culture-negative endocarditis

A 62-year-old male patient presented to the hospital with sustained fever and refractory skin ulcers. He had been under haemodialysis for 11 years and had received anti-coagulation therapy via warfarin following the artificial valve replacement surgery for 4 years. From his painful skin ulcers and necrotizing skin nodules with surrounding purpura over a wide range of the inferior limb, perineum, penis and breech and penile gangrene (Figure 1), calciphylaxis was di-agnosed by a criteria proposed by the Japanese Calciphy-laxis Study Group [1]. On admission, the white blood cell counts were 19.0 × 109 /L and the C-reactive protein level was 160 mg/L. Skin culture revealed isolation of methicil-lin-resistant Staphylococcus aureus, while standard cultur-ing of blood had never resulted in the isolation of any microorganisms. Administration of antibiotics was starte