Delayed diagnosis of non-uremic calciphylaxis in an unlikely patient

Calciphylaxis is a rare and often fatal condition most commonly associated with end-stage renal disease (ESRD). However, non-uremic calciphylaxis (NUC), occurring in the absence of severe renal dysfunction, remains a diagnostic challenge due to its rarity and nonspecific presentation. We report a rare case of non-uremic calciphylaxis in a 43-year-old African American woman with a history of alcoholic liver cirrhosis, an unusual presentation given her demographics and past medical history, which are not widely represented in the calciphylaxis literature. Further skewing the diagnostic challenge, initial skin biopsy ruled out calciphylaxis. The diagnostic complexity and risk of delayed treatment in such atypical presentations underscore the need for heightened clinical vigilance, especially in underrepresented populations. This case highlights the importance of considering NUC in the differential diagnosis of painful skin lesions, even in patients without traditional risk factors.