Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2019; 7(23): 4004-4010
Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.4004
Recuperation of severe tumoral calcinosis in a dialysis patient: A case report
Lukas Westermann, Lisa K Isbell, Marie K Breitenfeldt, Frederic Arnold, Elvira Röthele, Johanna Schneider, Eugen Widmeier
Lukas Westermann, Frederic Arnold, Elvira Röthele, Johanna Schneider, Eugen Widmeier, Department of Medicine IV, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany
Lisa K Isbell, Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany
Marie K Breitenfeldt, Dialysis Center Freiburg, Freiburg 79100, Germany
Author contributions: Westermann L, Isbell LK, Breitenfeldt MK, Arnold F, Röthele E, Schneider J and Widmeier E were involved in the patient’s medical care; Westermann L, Breitenfeldt MK and Widmeier E gathered detailed clinical information and analyzed data; Widmeier E and Westermann L wrote the paper; Widmeier E conceived of and directed the project; The manuscript was critically reviewed by all authors.
Informed consent statement: Informed consent was given in writing by the patient featured in this publication.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Eugen Widmeier, MD, Senior Research Fellow, Staff Physician, Department of Medicine IV, Medical Center University of Freiburg, Hugstetter Strasse 55, Freiburg 79106, Germany.
Received: August 20, 2019
Peer-review started: August 20, 2019
First decision: September 23, 2019
Revised: October 6, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: December 6, 2019

One of the common late sequela in patients with end-stage renal disease (ESRD) is the calcium phosphate disorder leading to chronic hypercalcemia and hyperphosphatemia causing the precipitation of calcium salt in soft tissues. Tumoral calcinosis is an extremely rare clinical manifestation of cyst-like soft tissue deposits in different periarticular regions in patients with ESRD and is characterized by extensive calcium salt containing space-consuming painful lesions. The treatment of ESRD patients with tumoral calcinosis manifestation involves an increase in or switching of renal replacement therapy regimes and the adjustment of oral medication with the goal of improved hypercalcemia and hyperphosphatemia.


We describe a 40-year-old woman with ESRD secondary to IgA-nephritis and severe bilateral manifestation of tumoral calcinosis associated with hypercalcemia, hyperphosphatemia and tertiary hyperparathyroidism. The patient was on continuous ambulatory peritoneal dialysis and treatment with vitamin D analogues. After switching her to a daily hemodialysis schedule and adjusting the medical treatment, the patient experienced a significant dissolution of her soft tissue calcifications within a couple of weeks. Complete remission was achieved 11 mo after the initial diagnosis.


Reduced patient compliance and subsequent insufficiency of dialysis regime quality contribute to the aggravation of calcium phosphate disorder in a patient with ESRD leading to the manifestation of tumoral calcinosis. However, the improvement of the treatment strategy and reinforcement of patient compliance enabled complete remission of this rare disease entity.

Keywords: End-stage renal disease, Renal replacement therapy - dialysis, Hyperparathyroidism, Hypercalcemia, Hyperphosphatemia, Tumoral calcinosis, Case report

Core tip: Tumoral calcinosis, a very rare disease entity, occurred in the described patient with end-stage renal disease due to disturbed calcium phosphate metabolism and insufficient quality of continuous ambulatory peritoneal dialysis. Complete remission was achieved by modification of the medical treatment and by switching to hemodialysis, which improved the dialysis quality. In general, to recuperate severe tumoral calcinosis, the treatment must be selected based on an understanding of the clinical background and the quality of the renal replacement therapy regime. In conclusion, this case report will significantly contribute to the reader’s understanding of tumoral calcinosis pathogenesis and treatment in patients with end-stage renal disease.