The importance of prevention of calciphylaxis in patients who are at risk and the potential fallibility of calcimimetics in the treatment of calciphylaxis for patients with secondary hyperparathyroidism.

A 43-year-old African American with end-stage renal disease (ESRD) associated with membranous nephropathy and a previously failed renal transplant had received cinacalcet to treat his secondary hyperparathyroidism. Serum calcium and phosphorus levels remained within normal limits, and serum parathyroid levels had dropped significantly following treatment initiation. However, within 7 months, the patient experienced extensive necrotic bilateral medial thigh ulcers. These were biopsied and found to be a result of calciphylaxis. The patient ultimately required an urgent subtotal parathyroidectomy and recovered well with completely healed ulcers.