Calciphylaxis complicated by NDM-1-producing Pseudomonas aeruginosa: first experience with cefepime-zidebactam alongside phage therapy in the USA.

Abstract

We report a case of calciphylaxis-a rare vasculopathy characterised by arteriolar calcification and ischaemic skin necrosis-in a young woman with acute myeloid leukaemia. Her ulcerated skin lesions became superinfected with a pan-resistant New Delhi metallo-β-lactamase-1-producing Pseudomonas aeruginosa. Although such infections in the USA have largely been associated with international travel, our patient harboured one of the earliest domestically acquired isolates. Management required novel therapeutic strategies, including the first use of cefepime-zidebactam in the USA alongside bacteriophage therapy and calciphylaxis-directed treatment. This case highlights the diagnostic complexity of calciphylaxis in atypical populations and shows the potential for innovative therapeutic approaches to achieve favourable outcomes in this rare, potentially fatal condition.