Calciphylaxis in the Upper GI Tract in an ESRD Patient: An Atypical Presentation and Review of Literature.

Calciphylaxis, also referred to as calcific uremic arteriolopathy (CUA), is a rare and life-threatening condition characterized by vascular calcification, ischemic tissue injury, and high morbidity and mortality. It is predominantly observed in patients with end-stage renal disease (ESRD) who are undergoing dialysis and typically presents with painful cutaneous ulcers. We report an exceptional case of gastric mucosal CUA in a dialysis-dependent ESRD patient, presenting with severe upper gastrointestinal bleeding in the absence of preceding skin lesions. Histopathologic examination of gastric biopsies confirmed vascular calcification consistent with CUA. Despite medical intervention, the patient's course was complicated by poor treatment adherence and subsequent fatal outcome. This case underscores the importance of maintaining high index of suspicion for atypical, visceral presentations of CUA in high-risk ESRD patients. This case was previously presented as a poster at the National Kidney Foundation 2025 Spring Clinical Meeting. Trial Registration: ClinicalTrials.gov identifier: NCT02278692.