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 Table of Contents  
IMAGES IN RHEUMATOLOGY
Year : 2018  |  Volume : 13  |  Issue : 2  |  Page : 135-136

Calcinosis cutis in connective tissue diseases


Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

Date of Web Publication24-May-2018

Correspondence Address:
Dr. Gianfranco Vitiello
Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Azienda Ospedaliero.Universitaria Careggi, 50134 Florence
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injr.injr_21_18

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  Abstract 


Keywords: Calcinosis cutis, connective tissue diseases, myositis, radiography, systemic sclerosis


How to cite this article:
Vitiello G, Palterer B, Parronchi P, Cammelli D. Calcinosis cutis in connective tissue diseases. Indian J Rheumatol 2018;13:135-6

How to cite this URL:
Vitiello G, Palterer B, Parronchi P, Cammelli D. Calcinosis cutis in connective tissue diseases. Indian J Rheumatol [serial online] 2018 [cited 2019 Aug 18];13:135-6. Available from: http://www.indianjrheumatol.com/text.asp?2018/13/2/135/228280



Calcinosis cutis (CC) is the deposition of calcium in the skin and subcutaneous tissues often associated with debilitating complications, such as pain, recurrent episodes of local inflammation, and functional impairment.[1] The two most common morphological patterns of CC in patients affected by connective tissue diseases (CTDs) are the nodular and the sheet-like.[2] CC has been frequently reported in systemic sclerosis (SSc) and myositis. CC has been associated in myositis presenting with overlapping SSc features, such as fingertip ulcerations.[3]

We present two different cases of calcium deposition detected by plain radiography.

Patient A was a 60-year-old female with amyopatic dermatomyositis with anti-MDA5 antibodies since 2014, in treatment with high-dose intravenous human immunoglobulins, hydroxychloroquine, and low-dose steroids, with an extensive and progressive cutaneous involvement complicated by painful diffuse plaque-shaped superficial CC bilaterally involving arms [Figure 1]a and [Figure 1]b and gluteus muscles. Therapy with cyclosporine A, oral bisphosphonates, and increased steroid doses reduced local pain but was unable to control plaque dimensions and progression.
Figure 1: (a) Plain radiography showing diffused subcutaneous sheet-like plaques of calcium depositions in the right arm. (b) Magnified detail of the sheet-like pattern of calcium deposition. (c) Plain radiography showing multiple macronodular calcium deposition (length 30 mm) in the armpit, which goes from skin deep into the subcutaneous tissue. (d) Magnified detail of the characteristic nodular pattern of calcium deposition

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Patient B was a 65-year-old female affected by limited SSc since 2000, in treatment with methotrexate and low-dose steroids, who progressively developed a mostly asymptomatic nodular CC involving hands, armpits [Figure 1]c and [Figure 1]d, and gluteus muscles. Histological specimens confirmed the presence of deep subcutaneous calcium salt deposition. No drug was added to therapy in the absence of debilitating complications.

CTD-related calcinosis is a not well-characterized, and is often a debilitating condition in which therapy still represents a real challenge for a physician. Calcium channel blockers, bisphosphonates, warfarin, intravenous immunoglobulins, and biologic agents have shown mixed results, and evidence for their efficacy is still lacking.[1],[4],[5] For these reasons, surgery is still considered the best treatment for CC, albeit recurrence is a common clinical outcome.[6]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Valenzuela A, Chung L. Calcinosis. Curr Opin Rheumatol 2015;27:542-8.  Back to cited text no. 1
    
2.
Shahi V, Wetter DA, Howe BM, Ringler MD, Davis MD. Plain radiography is effective for the detection of calcinosis cutis occurring in association with autoimmune connective tissue disease. Br J Dermatol 2014;170:1073-9.  Back to cited text no. 2
    
3.
Valenzuela A, Chung L, Casciola-Rosen L, Fiorentino D. Identification of clinical features and autoantibodies associated with calcinosis in dermatomyositis. JAMA Dermatol 2014;150:724-9.  Back to cited text no. 3
    
4.
Vayssairat M, Hidouche D, Abdoucheli-Baudot N, Gaitz JP. Clinical significance of subcutaneous calcinosis in patients with systemic sclerosis. Does diltiazem induce its regression? Ann Rheum Dis 1998;57:252-4.  Back to cited text no. 4
    
5.
Balin SJ, Wetter DA, Andersen LK, Davis MD. Calcinosis cutis occurring in association with autoimmune connective tissue disease. Arch Dermatol 2012;148:455-62.  Back to cited text no. 5
[PUBMED]    
6.
Lapner MA, Goetz TJ. High-speed burr debulking of digital calcinosis cutis in scleroderma patients. J Hand Surg Am 2014;39:503-10.  Back to cited text no. 6
[PUBMED]    


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