A rare case of penile calciphylaxis in an end stage kidney disease patient on continuous ambulatory peritoneal dialysis

Calciphylaxis is a rare but a devastating condition predominantly affecting patients with end-stage kidney disease (ESKD), characterized by calcification of small to medium-sized cutaneous arteries, leading to ischemia, painful skin necrosis, and high mortality. Penile calciphylaxis is an exceptionally rare manifestation with a poor prognosis. (1) We report a case of a 53-year-old male with type 2 diabetes mellitus, hypertension, and ESKD on continuous ambulatory peritoneal dialysis (CAPD) who developed a painful penile ulcer while on treatment for a necrotic foot ulcer with cellulitis. Diagnosis was supported by penile Doppler ultrasonography revealing penile arteriolar calcifications with absent distal blood flow. Despite broad-spectrum antibiotics and wound management, the patient succumbed to severe sepsis shortly after diagnosis. This case highlights the importance of early recognition of penile calciphylaxis in dialysis patients presenting with painful penile ulcers. We review diagnostic challenges and emerging treatment options, highlighting the need for multidisciplinary approaches to improve outcomes.