Calcinosis universalis in adult-onset dermatomyositis.

To cite: Bernardino V, Rodrigues A, Panarra A, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015211142 DESCRIPTION A 67-year-old woman of African origin with dermatomyositis, diagnosed 18 years before, and dystrophic calcification known for 5 years, presented at follow-up consultation with fever, increased muscle weakness (scapular and pelvic chains) and gluteus pain, with spontaneous purulent drainage. She was under cyclosporine 100 mg, prednisolone 10 mg and biphosphonates (alendronic acid and cholecalciferol). Physical examination revealed calcinosis universalis, with lesions spread over the chin, forearms, hands, abdomen, buttocks, thighs and knees (figure 1A). Her left buttock presented an inflamed fluctuating abscess (figure 1B). Proximal muscular strength test performed 3/5 on the arms and 4/5 on the legs. A 5×2.5 cm left gluteus abscess was identified over MRI and Methicillin-resistant Staphylococcus aureus was isolated, and treated with vancomycin and surgical drainage. Dermatomyositis exacerbation was controlled with increased doses of corticosteroids (figure 2). Calcinosis cutis, first described by Virchow in 1855, has been classified as dystrophic, metastatic, iatrogenic and idiopathic. Dystrophic calcinosis cutis is the most frequent type associated with dermatomyositis; when widespread, it is called ‘calcinosis universalis’. Although rare in adults (20%), these lesions are more frequent in juveniledermatomyositis (44–70%), as the onset of calcinosis is also much earlier in the young. 2 The exact physiopathology in its origin remains unclear. Dystrophic calcification is frequently painful, especially when the process involves areas close to joints or when ulceration occurs. No treatment is uniformly effective, but surgical excision of symptomatic lesions and medical treatment with biphosphonates, diltiazem and Figure 1 (A) Circular hyperpigmented lesions with palpable hard nodules in the subcutaneous tissue, corresponding to calcinosis universalis spots on both thighs; (B) Fluctuating abscess under a calcinosis spot on the left buttock.