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2</a> A&#41; The deposits were intensely birefringent under polarized light &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> B&#41; and the classic spiculated crystals of oxalate salts were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Fat necrosis was also observed&#46; On the basis of these histopathologic findings&#44; a diagnosis of oxalate crystal&#8211;induced vascular disease was established&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A review of the patient&#39;s records revealed that she had had repeated episodes of nephrolithiasis in both kidneys since the age of 40 years&#46; Previous tests had found a 24-hour urinary oxalate level of 101<span class="elsevierStyleHsp" style=""></span>mg&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;normal range&#44; 4-44<span class="elsevierStyleHsp" style=""></span>mg&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#59; at the time the patient was seen in our clinic&#44; the level of oxalic acid in the blood was 11&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;l &#40;normal value&#44; &#60;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#41;&#46; The results of further tests to rule out the possibility of associated calciphylaxis &#40;calcium levels&#44; phosphorus levels&#44; and arteriography&#41; were normal&#46; Electrocardiography and echocardiography showed no evidence of cardiac involvement and funduscopy revealed no retinal deposits&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient&#39;s clinical state gradually worsened&#46; The livedo reticularis increased in intensity on all of the limbs and necrosis appeared on the left heel&#44; the buttocks&#44; and the tips of the second and third fingers of the right hand&#46; She subsequently developed acute&#44; intense abdominal pain&#44; vomiting&#44; and refractory hypotension that led to her death&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">In a patient with terminal renal failure and a history of lithiasis&#44; the appearance of livedo reticularis should alert the clinician to consider a diagnosis of hyperoxaluria&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Hyperoxaluria is classified as primary or secondary &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The primary hyperoxalurias&#44; which have an autosomal recessive inheritance&#44; are divided into various subtypes that are distinguished from one another on the basis of the enzyme deficiency in the hepatocytes&#46; Type 1 primary hyperoxaluria is the most common&#46; It is caused by a deficiency of the pyridoxine-dependent hepatic peroxisomal enzyme alanine&#58;glyoxylate aminotransferase&#46; The gene that encodes this protein consists of 11 exons located on chromosome 2q37&#46;3&#46; About 30 mutations of this gene have been described to date&#46; Type 2 primary hyperoxaluria is caused by a deficiency of the cytosolic enzyme glyoxylate reductase&#47;hydroxypyruvate reductase&#46; Type 3 primary hyperoxaluria is linked to a mitochondrial-encoded enzyme&#46; It is likely that other as-yet-unidentified alterations also exist&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Secondary hyperoxaluria&#44; which is caused by excessive oxalate intake&#44; is seen in the context of other processes&#44; including hemodialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Because oxalate is excreted only via the kidneys&#44; renal failure of any origin that requires hemodialysis can lead to the saturation of oxalate salt in the tissues&#44; but always to a lesser extent than in the primary hyperoxalurias&#46; The excess oxalate precipitates as calcium oxalate&#44; first in the kidneys and later in other tissues&#46; It has been suggested that the appearance of renal calculi caused by primary hyperoxalurias&#8212;smooth&#44; whitish surface&#44; unorganized section&#44; and pure or virtually pure calcium oxalate monohydrate composition&#8212;is different from that of common calculi&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Cutaneous manifestations of hyperoxaluria are uncommon and very few cases have been reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;10</span></a> Most skin lesions of the primary hyperoxalurias are caused by vascular complications resulting from oxalate deposition in the arterial walls&#44; which leads to the appearance of livedo&#44; acrocyanosis&#44; and gangrene&#46; In secondary hyperoxaluria&#44; mild cutaneous manifestations are caused by extravascular deposition&#44; which leads to the appearance of acral or facial papules or nodules&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Our patient&#39;s advanced age at the time of diagnosis is noteworthy&#46; Primary hyperoxalurias generally have an early onset&#44; between the ages of 7 and 13 years&#59; however&#44; there have been cases&#44; like that of our patient&#44; in which the disease presents in the sixth decade of life&#46; Because of their rarity&#44; the primary hyperoxalurias are usually diagnosed between 24 and 33 years of age&#44; by which time many patients have already developed terminal renal failure&#46; Diagnosis of the primary hyperoxalurias is very challenging for clinicians&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Measurement of 24-hour urinary oxalate levels&#44; L-glycerate levels&#44; and the oxalate to creatinine ratio can be useful in the diagnostic process&#46; However&#44; once the patient has developed anuria these tests are no longer relevant&#46; When a primary hyperoxaluria is suspected&#44; the clinician can measure serum oxalate levels &#40;which were very high in our patient&#41; and&#44; depending on the results&#44; order liver biopsy and genetic testing &#40;which our patient did not undergo&#44; due to her rapid deterioration and death&#41;&#46; We suspect that our patient died as a result of acute mesenteric ischemia&#44; which has been described as a frequent cause of death in patients with primary hyperoxaluria&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The differential diagnosis should particularly include calciphylaxis&#46; Calciphylaxis has clinical manifestations similar to those found in our patient&#44; but it is usually seen in patients who are on long-term hemodialysis&#44; have alterations of the calcium&#47;phosphorus product or of parathyroid hormone levels&#44; or who present radiologic and histopathologic findings of soft-tissue calcification with basophilic calcium deposits&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment of hyperoxaluria depends on the cause&#46; Patients who retain kidney function can be prescribed oral pyridoxine&#44; which increases the activity of the deficient liver enzyme by acting as a cofactor&#46; In patients who have developed renal failure&#44; the only effective treatment is a combined liver and kidney transplant&#46; Because the liver is the site of the enzyme problem&#44; it must be transplanted at the same time as the kidney&#46; Conventional dialysis is not suitable for patients with renal failure because it cannot eliminate the excess oxalate synthesized in the liver&#46; Hemodialysis is more effective than peritoneal dialysis in eliminating oxalate&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Our patient&#39;s switch to peritoneal dialysis could explain the appearance of her cutaneous manifestations&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In summary&#44; we have presented the case of a 60-year-old woman with a history of recurrent nephrolithiasis and terminal renal failure who developed livedo reticularis and skin necrosis after starting a program of peritoneal dialysis&#46; Histopathology revealed the existence of calcium oxalate deposits in the arterial walls&#44; which supported a diagnosis of an underlying primary hyperoxaluria&#46; The patient&#39;s condition then deteriorated rapidly and she died a few months later&#44; before the type of primary hyperoxaluria could be confirmed by genetic testing or liver biopsy&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical Disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for the purpose of this study&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data&#46;</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that no patient data are disclosed in this article&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of Interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Oxalosis is a disease caused by the deposition of calcium oxalate in extrarenal tissues&#44; most commonly bone&#44; myocardium&#44; retina&#44; blood vessels&#44; and skin&#44; causing the clinical manifestations of the disease&#46; Involvement of the blood vessels of the skin can give rise to livedo reticularis&#44; acrocyanosis&#44; ulcers&#44; and gangrene&#46; We present the case of a 60-year-old woman with a history of recurrent renal lithiasis that had led to terminal renal failure requiring hemodialysis and&#44; subsequently&#44; peritoneal dialysis&#46; The patient developed tender red-violaceous skin discoloration of sudden onset&#44; consistent with livedo reticularis&#59; the lesions progressed to form ulcers&#46; Skin biopsy revealed oxalate vasculopathy&#46; In this article we describe the characteristics of this rare disorder&#44; its differentiation from calciphylaxis&#44; and the therapeutic options&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La oxalosis es una enfermedad derivada del dep&#243;sito de oxalato c&#225;lcico fuera del aparato urinario&#46; Los lugares de dep&#243;sito extrarrenales m&#225;s frecuentes incluyen el hueso&#44; el miocardio&#44; la retina&#44; los vasos sangu&#237;neos y la piel&#44; lo que da lugar a las manifestaciones cl&#237;nicas de esta enfermedad&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En la piel las alteraciones pueden deberse a la afectaci&#243;n de los vasos sangu&#237;neos&#44; lo que da lugar a la aparici&#243;n de cuadros de livedo reticularis&#44; acrocianosis&#44; &#250;lceras y gangrena&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de una mujer de 60 a&#241;os con historia de litiasis renal recidivante&#44; que le llev&#243; a una insuficiencia renal terminal que requiri&#243; hemodi&#225;lisis y posteriormente di&#225;lisis peritoneal&#46; La paciente desarroll&#243; de forma s&#250;bita la aparici&#243;n de elementos cut&#225;neos de color rojo-viol&#225;ceo&#44; dolorosos a la palpaci&#243;n compatibles con livedo reticularis que evolucionaron a &#250;lceras&#46; La biopsia cut&#225;nea revel&#243; una vasculopat&#237;a por oxalato&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En este art&#237;culo se describen las caracter&#237;sticas de este raro proceso&#44; su diagn&#243;stico diferencial con la calcifilaxis y las alternativas terap&#233;uticas&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Jorquera-Barquero E&#44; S&#250;arez-Marrero MC&#44; Fern&#225;ndez Gir&#243;n F&#44; Borrero Mart&#237;n JJ&#46; Oxalosis y livedo reticularis&#46; Actas Dermosifiliogr&#46; 2013&#59;104&#58;815&#8211;818&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A&#44; Deposits of amorphous material in the media of arterioles in the hypodermis &#40;hematoxylin-eosin&#44; original magnification &#215;&#160;37&#46;5&#41;&#46; B&#44; Intense birefringence of the material located in the arteriolar walls &#40;hematoxylin-eosin&#44; original magnification &#215;&#160;37&#46;5&#41;</p>"
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Case Report
Oxalosis and Livedo Reticularis
Oxalosis y livedo reticularis
E. Jorquera-Barqueroa,
Autor para correspondencia
jorroc@aedv.es

Corresponding author.
, M.C. Súarez-Marreroa, F. Fernández Girónb, J.J. Borrero Martínc
a Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Juan Ramón Jiménez, Huelva, Spain
b Servicio de Nefrología, Hospital Juan Ramón Jiménez, Huelva, Spain
c Servicio Anatomía Patológica, Hospital Juan Ramón Jiménez, Huelva, Spain
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    "titulo" => "Oxalosis and Livedo Reticularis"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Red-violaceous&#44; racemose&#44; macular skin lesions on the inner thigh&#44; consistent with livedo reticularis&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Oxalosis is defined as the systemic accumulation of calcium oxalate&#44; an insoluble salt of oxalic acid&#44; outside of the urinary tract&#46; The pathologic processes responsible for systemic oxalosis include primary and secondary hyperoxalurias&#46; Kidneys&#44; bone&#44; myocardium&#44; blood vessels&#44; and skin are the sites most susceptible to oxalate deposition and&#44; therefore&#44; to the appearance of clinical manifestations of oxalosis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The cutaneous findings associated with primary hyperoxaluria are usually caused by oxalate deposition in the blood vessel walls&#59; this can cause livedo reticularis&#44; acrocyanosis&#44; ulceration&#44; and peripheral gangrene&#46; Skin changes caused by hyperoxaluria secondary to renal insufficiency&#44; however&#44; are rare&#46; When such changes do occur&#44; they are the result of extravascular calcium oxalate deposition&#44; which leads to the appearance of calcified nodules and milium-like papules&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Description</span><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 60-year-old woman with terminal renal failure secondary to chronic lithiasic pyelonephritis who had been on hemodialysis followed by peritoneal dialysis for 3 years&#46; She presented red-violaceous&#44; racemose&#44; macular skin lesions that had appeared suddenly on the lower limbs and were very tender to palpation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Biopsy revealed the presence of deposits composed of a brownish material in the media of arterioles in the reticular dermis and hypodermis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> A&#41; The deposits were intensely birefringent under polarized light &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> B&#41; and the classic spiculated crystals of oxalate salts were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Fat necrosis was also observed&#46; On the basis of these histopathologic findings&#44; a diagnosis of oxalate crystal&#8211;induced vascular disease was established&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A review of the patient&#39;s records revealed that she had had repeated episodes of nephrolithiasis in both kidneys since the age of 40 years&#46; Previous tests had found a 24-hour urinary oxalate level of 101<span class="elsevierStyleHsp" style=""></span>mg&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;normal range&#44; 4-44<span class="elsevierStyleHsp" style=""></span>mg&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#59; at the time the patient was seen in our clinic&#44; the level of oxalic acid in the blood was 11&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;l &#40;normal value&#44; &#60;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#41;&#46; The results of further tests to rule out the possibility of associated calciphylaxis &#40;calcium levels&#44; phosphorus levels&#44; and arteriography&#41; were normal&#46; Electrocardiography and echocardiography showed no evidence of cardiac involvement and funduscopy revealed no retinal deposits&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient&#39;s clinical state gradually worsened&#46; The livedo reticularis increased in intensity on all of the limbs and necrosis appeared on the left heel&#44; the buttocks&#44; and the tips of the second and third fingers of the right hand&#46; She subsequently developed acute&#44; intense abdominal pain&#44; vomiting&#44; and refractory hypotension that led to her death&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">In a patient with terminal renal failure and a history of lithiasis&#44; the appearance of livedo reticularis should alert the clinician to consider a diagnosis of hyperoxaluria&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Hyperoxaluria is classified as primary or secondary &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The primary hyperoxalurias&#44; which have an autosomal recessive inheritance&#44; are divided into various subtypes that are distinguished from one another on the basis of the enzyme deficiency in the hepatocytes&#46; Type 1 primary hyperoxaluria is the most common&#46; It is caused by a deficiency of the pyridoxine-dependent hepatic peroxisomal enzyme alanine&#58;glyoxylate aminotransferase&#46; The gene that encodes this protein consists of 11 exons located on chromosome 2q37&#46;3&#46; About 30 mutations of this gene have been described to date&#46; Type 2 primary hyperoxaluria is caused by a deficiency of the cytosolic enzyme glyoxylate reductase&#47;hydroxypyruvate reductase&#46; Type 3 primary hyperoxaluria is linked to a mitochondrial-encoded enzyme&#46; It is likely that other as-yet-unidentified alterations also exist&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Secondary hyperoxaluria&#44; which is caused by excessive oxalate intake&#44; is seen in the context of other processes&#44; including hemodialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Because oxalate is excreted only via the kidneys&#44; renal failure of any origin that requires hemodialysis can lead to the saturation of oxalate salt in the tissues&#44; but always to a lesser extent than in the primary hyperoxalurias&#46; The excess oxalate precipitates as calcium oxalate&#44; first in the kidneys and later in other tissues&#46; It has been suggested that the appearance of renal calculi caused by primary hyperoxalurias&#8212;smooth&#44; whitish surface&#44; unorganized section&#44; and pure or virtually pure calcium oxalate monohydrate composition&#8212;is different from that of common calculi&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Cutaneous manifestations of hyperoxaluria are uncommon and very few cases have been reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;10</span></a> Most skin lesions of the primary hyperoxalurias are caused by vascular complications resulting from oxalate deposition in the arterial walls&#44; which leads to the appearance of livedo&#44; acrocyanosis&#44; and gangrene&#46; In secondary hyperoxaluria&#44; mild cutaneous manifestations are caused by extravascular deposition&#44; which leads to the appearance of acral or facial papules or nodules&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Our patient&#39;s advanced age at the time of diagnosis is noteworthy&#46; Primary hyperoxalurias generally have an early onset&#44; between the ages of 7 and 13 years&#59; however&#44; there have been cases&#44; like that of our patient&#44; in which the disease presents in the sixth decade of life&#46; Because of their rarity&#44; the primary hyperoxalurias are usually diagnosed between 24 and 33 years of age&#44; by which time many patients have already developed terminal renal failure&#46; Diagnosis of the primary hyperoxalurias is very challenging for clinicians&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Measurement of 24-hour urinary oxalate levels&#44; L-glycerate levels&#44; and the oxalate to creatinine ratio can be useful in the diagnostic process&#46; However&#44; once the patient has developed anuria these tests are no longer relevant&#46; When a primary hyperoxaluria is suspected&#44; the clinician can measure serum oxalate levels &#40;which were very high in our patient&#41; and&#44; depending on the results&#44; order liver biopsy and genetic testing &#40;which our patient did not undergo&#44; due to her rapid deterioration and death&#41;&#46; We suspect that our patient died as a result of acute mesenteric ischemia&#44; which has been described as a frequent cause of death in patients with primary hyperoxaluria&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The differential diagnosis should particularly include calciphylaxis&#46; Calciphylaxis has clinical manifestations similar to those found in our patient&#44; but it is usually seen in patients who are on long-term hemodialysis&#44; have alterations of the calcium&#47;phosphorus product or of parathyroid hormone levels&#44; or who present radiologic and histopathologic findings of soft-tissue calcification with basophilic calcium deposits&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment of hyperoxaluria depends on the cause&#46; Patients who retain kidney function can be prescribed oral pyridoxine&#44; which increases the activity of the deficient liver enzyme by acting as a cofactor&#46; In patients who have developed renal failure&#44; the only effective treatment is a combined liver and kidney transplant&#46; Because the liver is the site of the enzyme problem&#44; it must be transplanted at the same time as the kidney&#46; Conventional dialysis is not suitable for patients with renal failure because it cannot eliminate the excess oxalate synthesized in the liver&#46; Hemodialysis is more effective than peritoneal dialysis in eliminating oxalate&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Our patient&#39;s switch to peritoneal dialysis could explain the appearance of her cutaneous manifestations&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In summary&#44; we have presented the case of a 60-year-old woman with a history of recurrent nephrolithiasis and terminal renal failure who developed livedo reticularis and skin necrosis after starting a program of peritoneal dialysis&#46; Histopathology revealed the existence of calcium oxalate deposits in the arterial walls&#44; which supported a diagnosis of an underlying primary hyperoxaluria&#46; The patient&#39;s condition then deteriorated rapidly and she died a few months later&#44; before the type of primary hyperoxaluria could be confirmed by genetic testing or liver biopsy&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical Disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for the purpose of this study&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data&#46;</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that no patient data are disclosed in this article&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of Interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Oxalosis is a disease caused by the deposition of calcium oxalate in extrarenal tissues&#44; most commonly bone&#44; myocardium&#44; retina&#44; blood vessels&#44; and skin&#44; causing the clinical manifestations of the disease&#46; Involvement of the blood vessels of the skin can give rise to livedo reticularis&#44; acrocyanosis&#44; ulcers&#44; and gangrene&#46; We present the case of a 60-year-old woman with a history of recurrent renal lithiasis that had led to terminal renal failure requiring hemodialysis and&#44; subsequently&#44; peritoneal dialysis&#46; The patient developed tender red-violaceous skin discoloration of sudden onset&#44; consistent with livedo reticularis&#59; the lesions progressed to form ulcers&#46; Skin biopsy revealed oxalate vasculopathy&#46; In this article we describe the characteristics of this rare disorder&#44; its differentiation from calciphylaxis&#44; and the therapeutic options&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La oxalosis es una enfermedad derivada del dep&#243;sito de oxalato c&#225;lcico fuera del aparato urinario&#46; Los lugares de dep&#243;sito extrarrenales m&#225;s frecuentes incluyen el hueso&#44; el miocardio&#44; la retina&#44; los vasos sangu&#237;neos y la piel&#44; lo que da lugar a las manifestaciones cl&#237;nicas de esta enfermedad&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En la piel las alteraciones pueden deberse a la afectaci&#243;n de los vasos sangu&#237;neos&#44; lo que da lugar a la aparici&#243;n de cuadros de livedo reticularis&#44; acrocianosis&#44; &#250;lceras y gangrena&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de una mujer de 60 a&#241;os con historia de litiasis renal recidivante&#44; que le llev&#243; a una insuficiencia renal terminal que requiri&#243; hemodi&#225;lisis y posteriormente di&#225;lisis peritoneal&#46; La paciente desarroll&#243; de forma s&#250;bita la aparici&#243;n de elementos cut&#225;neos de color rojo-viol&#225;ceo&#44; dolorosos a la palpaci&#243;n compatibles con livedo reticularis que evolucionaron a &#250;lceras&#46; La biopsia cut&#225;nea revel&#243; una vasculopat&#237;a por oxalato&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En este art&#237;culo se describen las caracter&#237;sticas de este raro proceso&#44; su diagn&#243;stico diferencial con la calcifilaxis y las alternativas terap&#233;uticas&#46;</p>"
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2013 Diciembre 20 7 27
2013 Noviembre 20 5 25
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?