# Calciphylaxis Raising Suspicion for Factitious Dermatitis: A Diagnostic Challenge

## TL;DR

A young woman with complex medical history and leg ulcers was initially suspected of factitious dermatitis but was later diagnosed with calciphylaxis, highlighting the need for thorough evaluation.

## Contribution

Highlights the diagnostic challenge of distinguishing calciphylaxis from factitious dermatitis through a case report.

## Key findings

- The patient's complex medical history and atypical presentation initially suggested factitious dermatitis.
- Calciphylaxis was ultimately diagnosed, emphasizing the need to rule out organic causes before psychiatric diagnoses.
- A multidisciplinary approach is crucial in managing such complex and rare conditions.

## Abstract

The term factitious dermatitis is often used interchangeably with dermatitis artefacta in the literature to describe self-inflicted skin injuries for which patients deny their responsibility. Its clinical presentation is diverse, and suspicion usually arises from clinical history and examination. However, it is crucial to exclude organic causes that may explain the lesions. We report the case of a young woman admitted for investigation of leg ulcers evolving over two months. Her medical history included renal disease since childhood, requiring long-term renal replacement therapy, as well as total thyroidectomy, hemiparathyroidectomy, acute alithiasic pancreatitis, secondary hypoparathyroidism, arterial hypertension, attention deficit, dyslexia, depression, and anxiety disorder. During hospitalization, the medical history and atypical presentation raised the suspicion of factitious dermatitis. Ultimately, the diagnosis of calciphylaxis was confirmed, a rare and life-threatening disease. In this case report, we stress the importance of a comprehensive assessment to rule out organic causes before establishing a primarily psychiatric or factitious diagnosis, while also emphasizing the value of a multidisciplinary approach in these cases.