Dystrophic calcinosis cutis as a sign of autoimmune connective tissue disease

Abstract

Dystrophic calcinosis cutis ( is the deposition of calcified material in the skin and subcutaneous tissue in the settings of normal serum calcium and phosphate levels C alcinosis cutis is the most common in association with autoimmune connective tissue disease ( including dermatomyositis 30 to 38 systemic sclerosis 18 to 22 mixed connective tissue disease ( CTD)(about 5 systemic lupus erythematosus ( (about 3 overlap CTD (about 6 We report a case report of dystrophic calcinosis cutis as a sign of ACTD 1 2 A 66 year old female was referred to the dermatovenereologist with painful erythematous variously sized plaques and nodes on the upper arms, back, abdomen, buttocks (fig 1 2 She was diagnosed with diabetes, podagra autoimmune thyroiditis, secondary anemia, arterial hypertension Four stage kidney failure caused by chronic pyelonephritis lasting for 10 years was determined, which caused secondary anemia, hyperparathyroidism, hyperuricemia Before developing painful nodes her baseline antinuclear antibodies ( were negative Diagnosis of DCC was made on the basis of radiological examination (deposits of subcutaneous calcium), histological examination of the node (deposits of calcium in the subcut aneous tissue (fig 3 Calcium and phosphate levels in the serum were normal Oncological diseases and other forms of calcinosis cutis were excluded To differentiate CTD skin biopsy from plaque and serological laboratory tests were made Clinical histological signs and positive immunological tests linear IgG and C 3 complement deposits in the basal membrane (direct immunofluorescence ( fig 4 5 positive antinuclear antibody ANA 1 100 (with speckled pattern 3 positive double stranded DNA ( 44 32 kU /l ( 12 kU / directed to the diagnosis of subacute lupus erythematosus Detailed autoantibody screening revealed positive anti Mi 2 alfa anti Mi 2 beta 2 anti Ku 2 anti Scl 70 anti PM Scl 00 anti RP 11 anti RP 155 I n our case, DCC needs to be differentiated from calciphylaxis which could be caused by renal failure C alciphylaxis is characterized by calcification of small dermal and subcutaneous arteries while DCC is characterized by deposits of subcutaneous calcium Based on the literature review, DCC usually appears secondary to ACTD Additional investigation of anti centromere autoantibodies, muscle enzymes, kidney biopsy, electromyography would be helpful to specify accurate ACTD [1,2,3].