| Atherosclerotic vascular disease |
Symptoms of claudication, weak peripheral pulses, distal distribution, abnormal ankle-brachial index |
Can be proximal or distal distribution, severe pain, dermal arteriolar calcification on skin biopsy |
| Cholesterol embolization |
Usually in acral distribution, may have features associated with renal or gastrointestinal ischemia, cholesterol clefts on skin biopsy |
Can be proximal or distal distribution, dermal arteriolar calcification on skin biopsy |
| Nephrogenic systemic fibrosis |
Brawny plaques, thickened skin, history of exposure to gadolinium, moderate intensity pain, marked increase in spindle cells and fibrosis on skin biopsy |
Severe pain, dermal arteriolar calcification on skin biopsy |
| Oxalate vasculopathy |
Acral distribution, history of calcium oxalate stones, birefringent, yellowish-brown, polarizable crystalline material deposition in the dermis and arteriolar wall on skin biopsy |
Can be proximal or distal distribution, calcium deposits non-polarizable |
| Purpura fulminans |
Usually seen in the settings such as septic shock or disseminated intravascular coagulation, diffuse body distribution, rapid progression, clinical features of shock |
Unlikely to have diffuse whole body distribution, absence of serological features of disseminated intravascular coagulation, dermal arteriolar calcification on skin biopsy |
| Vasculitis |
Systemic features of vasculitis, serological test abnormalities (e.g. cryoglobulins), no dermal arteriolar calcification on skin biopsy, unlikely to have full-thickness necrosis or large areas of involvement |
Absence of systemic features and serological abnormalities of vasculitis (unless autoimmune disease is a trigger for calciphylaxis), black eschar, dermal arteriolar calcification on skin biopsy |
| Warfarin necrosis |
Typically seen within the first 10 days of warfarin initiation, manifestation of paradoxical hypercoagulable state created by a transient imbalance in the procoagulant and anticoagulant pathways warfarin discontinuation associated with clinical improvement in majority of cases |
Warfarin exposure of prolonged duration when calciphylaxis associated with warfarin therapy, black eschar, dermal arteriolar calcification on skin biopsy |
