Issue: 2016 > May > photo quiz

A haemodialysis patient with progressive leg pain

J. Hanssen, K. Berend, J. Tai, N. Vinke
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A 71-year-old man experienced progressive pain in his left upper leg and groin over a period of several months. He had been receiving haemodialysis for ten years because of end-stage renal disease due to chronic pyelonephritis. Medication included alfacalcidol and cinacalcet. On examination, multiple large tender rubber-like nodules were palpated in the symphysis and upper leg region. His monthly lab results usually showed slightly raised serum calcium and phosphate levels around 2.80 mmol/l and 1.90 mmol/l respectively. The parathyroid hormone level was generally above 1200 pg/ml (normal range 11-62 pg/ml) due to noncompliance. Pelvis radiography and computed tomography showed massive cauliflower-like calcifications with fluid levels in the pubic region, lesser pelvis and the proximal femora (figure 1 and 2).