A case of Severe Calcinosis Cutis in Dermatomyositis
Oana Dickinson MD, Nitika Ghattaura MD, Elie Gertner MD
From the Department of Medicine, Division of Rheumatology
University of Minnesota Medical School
Abstract 3000 character including spaces; Arial 11. DickinsonOanaAbstarct2015
Calcinosis cutis (CC) is a chronic condition characterized by insoluble deposits of calcium in the
subcutaneous tissue and skin. It is commonly associated with autoimmune connective tissue
diseases and can be a source of chronic pain and dramatic functional disability. There is no
standard treatment for CC.
We are describing a case of severe CC in a patient (pt) with adult form of juvenile
dermathomyositis (JDM). A 63 year old female with a past medical history of severe resistant
JDM, CKD stage IV, DM type II presented with signs worrisome of stroke. Pt was diagnosed
with JDM in 1996 by muscle biopsy. During the following years multiple therapies were started:
corticosteroid therapy, Metrothraxate, Imuran, Dapsone, IVIG, Plaquenil, Cytoxan, Cellcept.
One year after her diagnosis, she started developing small subcutaneous hard noduels over the
upper arms and breasts area. A biopsy was done in 4/1997 which showed panniculitis in lobular
fashion. In 7/1997 was noticed that her nodules have become calcific and they are worsening.
Bisphosphonates were started on 6/17/2002.In 12/2003 patient had a repeat tissue biopsy of
abdominal nodules that showed calcified tissue. Tacrolimus cream was started. Since 2003
therapy was continued with MTX, MMF, and prednisone. In January 2014 pt developed AKI /
CKD and both MMF and MTX were held. In Sept 2014 due to extensive calcinosis cutis and
several infected lesions patient was following an antibiotic treatment following with ID and
Dermatology. Physical exam was positive for multiple subcutaneous nodules and plaques on
upper extremities, anterior chest, lower abdomen and inner thighs. Pt had a very limited range
of motion of bilateral shoulders and elbows due to calcific plaques and nodules with open skin
ulcers on medial part of upper extremities bilateral draining a white thick fluid. Total
protein/creatinine ratio was 9.4. Antinuclear antibody was positive. A XR of elbow showed
extensive soft tissue calcifications obscuring the elbow joint. A XR of abdomen and pelvis
showed extensive, severe soft tissue calcifications. A XR of right hand showed multiple course
soft tissue calcifications on the volar soft tissue of thumb and distal aspect of index along with
generalized demineralization. A carotid US showed only mild atheromaosus plaques in the
carotids arteries.
In DM, calcification occurs three times more commonly in JDM then in the adult-onset form and
may be observed in 40-70%. Calcifications present as a firm dermal or subcutaneous papules
or nodules that are frequent most prominent in areas of micro trauma such as elbows, knees,
buttocks, hands. Most pts develop complications such as cosmetic disfigurement, persistent
ulceration with infection and mechanical compromise. Treatment of dystrophic calcifications is
challenging. There are no control trials or an established of treatment for CC.