Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive, severe, burning pain associated with violaceous, retiform, indurated subcutaneous plaques. Lesions are primarily located in adipose-rich areas (abdomen, thighs, buttocks). History of ESRD on hemodialysis. Pain is disproportionate to clinical appearance. No recent trauma or identifiable precipitating factors.
Clinical Examination Findings
Patient appears in acute distress due to intractable pain. Vitals stable but may show tachycardia. Skin examination reveals tender, purpuric, retiform plaques with central necrosis and eschar formation. Peripheral pulses may be palpable (distinguishing from PAD). Signs of malnutrition and cachexia noted.
Treatment Protocol
Multidisciplinary approach: 1. Wound care: Non-surgical debridement (avoid aggressive surgery). 2. Pharmacotherapy: Sodium thiosulfate IV, aggressive pain management (opioids/gabapentinoids), optimization of calcium-phosphate product (cinacalcet, phosphate binders). 3. Dialysis optimization: Increase frequency/duration, low-calcium dialysate. 4. Wound dressing: Advanced dressings to manage exudate.