Idiopathic calcinosis cutis universalis

Case A 12-years old girl with complaints of multiple lumps on her body since 1 years prior to admission. Two years prior to admission patient complained of movement limitation due to pain when doing leg lifting, squatting and standing up. One years prior to admission patient got bilateral symmetrical lumps on hip, corn size and getting bigger. Two months prior to admission the lumps got ruptured and patient felt pain. From past history no calcium supplementation, no allergy. In physical examination patient vital sign are within normal limits, moderate malnourished. From head and neck no enlargement of lymph nodes. Heart and lungs are normal. Abdomen is normal and no sign of edema on extremities. On the extremities multiple bilateral and symmetrical lumps, corn size and coin size. On the hip multiple bilateral and symmetrical lumps. The laboratory investigations revealed within normal limits. Biochemical examinations gave normal results for complete hemogram, erythrocyte sedimentation rate, blood sugar, uric acid, electrolyte, liver function and kidney function tests. Serum calcium 1.2 (normal 1.2 – 1.48 mg/dl), phosphorus 4.2 (normal 2.4-5.1 mg/dl), 25-hydroxyvitamin D 18.7(normal 17-54 ng/dl), parathormone (PTH) 29.46 (normal 15-65 pg/dl), and magnesium 2.0 mg/dl (normal 1.3-2.7 mg/dl). On radiologic findings there are multiple calcification in soft tissue layer on humeral, antebrachial, femoral and crural bilateral. On tissue biopsy there are cystic space containing calcified material separated by fibrous tissue. Patient underwent treatment with bisphosphonate using zolendronate and surgical exicion