Images in Clinical Rheumatology
Calcinosis Universalis in Adult-onset Dermatomyositis
Calcinosis universalis en paciente con dermatomiositis
Marta Novella Navarro
, María del Mar Muñoz Gómez, Juan Salvatierra Ossorio
Corresponding author
Servicio de Reumatología, Complejo Hospitalario Universitario de Granada, Granada, Spain
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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. <span class="elsevierStyleItalic">Streptococcus mitis</span> and <span class="elsevierStyleItalic">Escherichia coli</span> 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 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), pelvis and thighs, with intramuscular calcification proximal to the distal insertion of vastus medialis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and generalized osteopenia.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> 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.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> The most common complications are suppuration of the calcific material and colonization by microorganisms and superinfection of the nodules.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-04-02" "fechaAceptado" => "2016-05-26" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Novella Navarro M, Muñoz Gómez MM, Salvatierra Ossorio J. Calcinosis <span class="elsevierStyleItalic">universalis</span> en paciente con dermatomiositis. Reumatol Clin. 2017;13:359–360.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 929 "Ancho" => 1500 "Tamanyo" => 177729 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Calcinosis universalis in abdomen and pelvis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 952 "Ancho" => 900 "Tamanyo" => 85243 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Calcinosis in thighs with intramuscular calcification proximal to the distal insertion of the vastus medialis. Intramedullary nail secondary to femoral fracture.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calcinosis in rheumatic diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Boulman" 1 => "G. Slobodin" 2 => "M. Rozebaum" 3 => "I. 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Tiev" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2010.08.003" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2011" "volumen" => "41" "paginaInicial" => "48" "paginaFinal" => "60" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21047670" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001300000006/v1_201710250854/S2173574317300916/v1_201710250854/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001300000006/v1_201710250854/S2173574317300916/v1_201710250854/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317300916?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 12 | 26 |
| 2024 October | 78 | 27 | 105 |
| 2024 September | 75 | 16 | 91 |
| 2024 August | 72 | 33 | 105 |
| 2024 July | 60 | 31 | 91 |
| 2024 June | 76 | 35 | 111 |
| 2024 May | 70 | 36 | 106 |
| 2024 April | 82 | 25 | 107 |
| 2024 March | 100 | 20 | 120 |
| 2024 February | 77 | 24 | 101 |
| 2024 January | 67 | 22 | 89 |
| 2023 December | 58 | 23 | 81 |
| 2023 November | 62 | 18 | 80 |
| 2023 October | 70 | 29 | 99 |
| 2023 September | 83 | 35 | 118 |
| 2023 August | 54 | 15 | 69 |
| 2023 July | 76 | 22 | 98 |
| 2023 June | 63 | 26 | 89 |
| 2023 May | 100 | 22 | 122 |
| 2023 April | 71 | 4 | 75 |
| 2023 March | 125 | 41 | 166 |
| 2023 February | 98 | 24 | 122 |
| 2023 January | 103 | 15 | 118 |
| 2022 December | 122 | 39 | 161 |
| 2022 November | 143 | 24 | 167 |
| 2022 October | 109 | 30 | 139 |
| 2022 September | 117 | 36 | 153 |
| 2022 August | 104 | 49 | 153 |
| 2022 July | 92 | 29 | 121 |
| 2022 June | 107 | 38 | 145 |
| 2022 May | 114 | 45 | 159 |
| 2022 April | 134 | 47 | 181 |
| 2022 March | 104 | 46 | 150 |
| 2022 February | 123 | 32 | 155 |
| 2022 January | 110 | 52 | 162 |
| 2021 December | 65 | 41 | 106 |
| 2021 November | 72 | 42 | 114 |
| 2021 October | 161 | 60 | 221 |
| 2021 September | 48 | 34 | 82 |
| 2021 August | 81 | 42 | 123 |
| 2021 July | 87 | 31 | 118 |
| 2021 June | 71 | 31 | 102 |
| 2021 May | 77 | 50 | 127 |
| 2021 April | 183 | 117 | 300 |
| 2021 March | 84 | 20 | 104 |
| 2021 February | 50 | 25 | 75 |
| 2021 January | 48 | 22 | 70 |
| 2020 December | 44 | 19 | 63 |
| 2020 November | 72 | 25 | 97 |
| 2020 October | 31 | 21 | 52 |
| 2020 September | 65 | 27 | 92 |
| 2020 August | 37 | 20 | 57 |
| 2020 July | 35 | 22 | 57 |
| 2020 June | 49 | 13 | 62 |
| 2020 May | 33 | 15 | 48 |
| 2020 April | 33 | 17 | 50 |
| 2020 March | 25 | 5 | 30 |
| 2020 February | 1 | 0 | 1 |
| 2019 October | 2 | 0 | 2 |
| 2018 December | 3 | 0 | 3 |
| 2018 July | 1 | 0 | 1 |
| 2018 May | 3 | 0 | 3 |
| 2018 March | 29 | 7 | 36 |
| 2018 February | 55 | 20 | 75 |
| 2018 January | 69 | 30 | 99 |
| 2017 December | 51 | 37 | 88 |
| 2017 November | 72 | 41 | 113 |
| 2017 October | 16 | 16 | 32 |
| 2017 September | 4 | 11 | 15 |
| 2017 August | 3 | 12 | 15 |
| 2017 July | 2 | 10 | 12 |
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