A woman with metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis presented to our hospital with hepatic encephalopathy, acute kidney injury, and painful skin lesions. A skin biopsy and broad work-up led to a diagnosis of non-uremic calciphylaxis. Despite treatment with IV sodium thiosulfate therapy, the patient ultimately passed away from infectious complications. This case highlights the need to recognize non-uremic calciphylaxis, which is a dermatologic complication associated with both alcohol-associated and MASH cirrhosis. While treatment options are currently limited, recognition of non-uremic calciphylaxis is crucial for enabling honest conversations with patients about prognosis.