|IMAGES IN RHEUMATOLOGY
|Year : 2018 | Volume
| Issue : 2 | Page : 135-136
Calcinosis cutis in connective tissue diseases
Gianfranco Vitiello, Boaz Palterer, Paola Parronchi, Daniele Cammelli
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
|Date of Web Publication||24-May-2018|
Dr. Gianfranco Vitiello
Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Azienda Ospedaliero.Universitaria Careggi, 50134 Florence
Source of Support: None, Conflict of Interest: None
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
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. The two most common morphological patterns of CC in patients affected by connective tissue diseases (CTDs) are the nodular and the sheet-like. 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.
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.,, For these reasons, surgery is still considered the best treatment for CC, albeit recurrence is a common clinical outcome.
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
Conflicts of interest
There are no conflicts of interest.
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