末期腎衰竭於未開始透析患者的罕見併發症：生殖器官動脈血管鈣化病變

Penile Calciphylaxis Complicating Newly Diagnosed End Stage Kidney Disease in a Non-Dialysis Patient

一位33歲男性因為鈣化尿毒症性小動脈病變而患有視力模糊和劇烈疼痛以及陰莖頭龜組織壞死變黑的病例，理學檢查呈現陰莖與陰囊呈現黑色焦痂同時乾性壞疽出現在軀幹與四肢。血液檢查呈現末期腎臟病，腹部斷層掃描檢查結果為廣泛性血管鈣化病變，特別是生殖器官動脈。鈣化尿毒症性小動脈病變被認為是缺血性壞死的一種形式，主要表現為身體肥胖，如軀幹，臀部或遠端肢體。儘管鈣化尿毒症性小動脈病變的發病機制尚不完全清楚，但繼發性副甲狀腺功能亢進症，高磷血症和鈣磷積累增加有關。生殖器官動脈血管鈣化病變是屬於非脂肪部分的非常罕見的疾病。由於此尿毒併發症是高死亡率，因此需要早期診斷和多種治療方式。

We present a case involving a 33-year-old man suffering two weeks of blurred vision and progressive pain and black discoloration of glans penis due to calcific uremic arteriolopathy. The hard black eschar was noticed over the distal third of the penis and the part of the scrotum. Dry gangrene was also present in both feet, the right ankle and thigh. An unenhanced computed tomography scan of the abdomen showed extensive vascular calcifications, particularly the dorsal penile vessels. Calcific uremic arteriolopathy is a form of ischemic necrosis predominantly implicating areas of adiposity in the body, including the trunk, buttocks, or distal extremities. Although the pathogenesis of calcific uremic arteriolopathy is not completely understood, studies have discussed the involvement of secondary hyperparathyroidism, hyperphosphatemia, and increased calcium phosphorus product. Penile calciphylaxis is a rare disease because glans penis is not an adipose area. Early diagnosis and multidisciplinary approach are necessary due to high possibility of mortality.