The patient was a 71-year-old woman with a history of breast cancer for which she was treated in 2000, and of dermatomyositis (DM) since 1982, which remained stable as her underlying disease with immunosuppressive therapy (prednisone at 10mg/day, azathioprine, hydroxychloroquine), colchicine and bisphosphonates. She was referred to our department with fever that had developed 3 days earlier, with no clear site of infection. As cutaneous manifestations, aside from lesions compatible with Gottron's papules on upper extremities, the patient presented with “calcinosis cutis” consisting of scattered nodules and plaques, some ulcerated and suppurating in both gluteal regions and on right elbow. Specimens were taken to culture the exudate. Streptococcus mitis and Escherichia coli were isolated. As both are sensitive to ciprofloxacin, antibiotic therapy was initiated immediately, and there was a significant clinical improvement. Plain radiography revealed calcinosis universalis in abdomen (Fig. 1), pelvis and thighs, with intramuscular calcification proximal to the distal insertion of vastus medialis (Fig. 2) and generalized osteopenia.

Fig. 1.

Calcinosis universalis in abdomen and pelvis.

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Fig. 2.

Calcinosis in thighs with intramuscular calcification proximal to the distal insertion of the vastus medialis. Intramedullary nail secondary to femoral fracture.

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The calcification of soft tissue in DM is more common in long-standing diseases, especially in the juvenile form (JDM), in which it is 3-fold more frequent than in adult-onset DM.1,2 It is correlated with the severity of the disease, as well as with the presence of vascular disease and delays in or refractoriness to treatment of the underlying DM.3,4

Calcium deposits usually appear in the form of subcutaneous nodules with a predilection for regions subjected to repeated microtrauma (elbows, knees and buttocks), and intramuscular and fascial calcifications are less frequent.5 The most common complications are suppuration of the calcific material and colonization by microorganisms and superinfection of the nodules.6