case_images: PMC11653006_01
case_images: (A) The skin lesions caused by calciphylaxis. Multiple painful skin ulcers on the anterior part of the lower right leg were resistant to treatment. (B) One month after admission, the patient experienced a fracture of the ninth thoracic vertebra. Arrows indicate the fracture site. (C) Five months after admission, the patient sustained six new vertebral fractures. All fractures were in the thoracic spine. (D) The eighth dose of denosumab was delayed, and the patient had thoracic and lumbar vertebral fractures that appeared to be a rebound from the denosumab.
case_images: ziae154f1.jpg
case_images: PMC11653006_01_ziae154f1.jpg
case_images: f1
case_images: In June 2019, the patient presented to the Dermatology Department with multiple painful skin ulcers on the anterior part of the right lower leg that did not improve (Figure 1A). Th9 fracture (Figure 1B). The patient was treated with braces. The patient had a Th8 fracture without any trigger in late September, a Th7 fracture in late October, and Th4, Th5, and Th6 vertebral fractures in late November (Figure 1C). This delay caused a rebound fracture, resulting in Th12, L2, L3, and L4 fractures (Figure 1D).
case_images: (A) Spinal BMD levels decreased rapidly after hospitalization; however, they gradually increased after the second denosumab inoculation. (B) Hip BMD levels decreased rapidly after hospitalization; however, they gradually increased after the second denosumab inoculation. An asterisk indicates the date of admission, and a double asterisk shows the date of the first denosumab implementation. *indicates the admission date, and **indicates the administration of denosumab.
case_images: ziae154f2.jpg
case_images: PMC11653006_01_ziae154f2.jpg
case_images: f2
case_images: BMD (Figure 2-1A) and total hip BMD (Figure 2-1B)). Blood test results (corrected Ca (Figure 2-2A), P (Figure 2-2B), estimated glomerular filtration rate (eGFR) (Figure 2-2C), P1NP (Figure 2-2D), TRACP-5b (Figure 2-2E), and intact parathyroid hormone (intact PTH) (Figure 2-2F)) are shown in the graphs.