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Year : 2014  |  Volume : 29  |  Issue : 4  |  Page : 278-279  

A case of adult dermatomyositis with calcinosis universalis


1 Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication11-Oct-2014

Correspondence Address:
Bhagwant Rai Mittal
Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.142649

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   Abstract 

Calcinosis, although frequent in juvenile dermatomyositis is a rare finding in adults. It is more common in later phases of the disease, involving sites under chronic stress and trauma. We present a 52-year-old female patient of dermatomyositis who on single-photon emission computed tomography/computed tomography hybrid images showed exclusive subcutaneous fat calcinosis, also known as calcinosis universalis - a phenomenon that is only rarely reported in adult-onset dermatomyositis.

Keywords: Adult dermatomyositis, calcinosis universalis, hybrid single-photon emission computed tomography/computed tomography


How to cite this article:
Jayanthi MR, Basher RK, Bhadada SK, Bhattacharya A, Mittal BR. A case of adult dermatomyositis with calcinosis universalis. Indian J Nucl Med 2014;29:278-9

How to cite this URL:
Jayanthi MR, Basher RK, Bhadada SK, Bhattacharya A, Mittal BR. A case of adult dermatomyositis with calcinosis universalis. Indian J Nucl Med [serial online] 2014 [cited 2019 Dec 12];29:278-9. Available from: http://www.ijnm.in/text.asp?2014/29/4/278/142649

A 52-year-old female patient with known dermatomyositis diagnosed 2 years back, presented with complaints of low backache and limitation of movements around bilateral hip joints. On examination, multiple palpable nodules were found in the region of the right arm and right gluteal region. Radiograph of the right arm showed soft tissue calcification around the right humerus. Whole-body bone scintigraphy [Figure 1] performed to assess the extent of calcinosis showed multiple areas of irregular tracer deposition in the soft tissues of right upper limb, left arm, in the bilateral gluteal region, anterior and posterior aspects of the thighs and anterior aspect of bilateral proximal part of the leg. Single-photon emission computed tomography/computed tomography images [Figure 2]a-d of the pelvis and upper part of bilateral thighs showed tracer localization to extensive calcification exclusively in the subcutaneous fat of buttocks and anterior and lateral part of thigh on both sides, with normal pelvic viscera.
Figure 1: Tc-99m-methylene diphosphonate whole-body bone scintigraphy in anterior and posterior projections showing multiple areas of irregular tracer deposition in the soft tissues of right upper limb, left arm, in the bilateral gluteal region, anterior and posterior aspects of the thighs and anterior aspect of bilateral proximal part of leg

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Figure 2: Single photon emission computed tomography/computed tomography (CT) (a) coronal CT, (b) coronal fused, (c) transaxial CT and (d) transaxial fused images of the pelvis and upper part of bilateral thighs showed tracer localization to extensive calcifi cation exclusively in the subcutaneous fat of buttocks and anterior and lateral part of thigh (arrow on right sided involvement) on both sides

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Calcinosis is a well-documented manifestation seen in up to 40% of patients with juvenile dermatomyositis, but is an uncommon feature in adult-onset dermatomyositis. [1],[2] Calcinosis in connective tissue diseases is associated with persistent disease activity and disease chronicity. [3] Calcinosis universalis is characterized by the deposit of calcium salts in skin, subcutaneous tissue, tendons and muscles without any metabolic disorder or tissue injury. [4],[5] Mechanism of these calcium deposits is not clear, but it could result from an intracellular accumulation of calcium secondary to an alteration of the cellular membrane by traumatism and inflammation. [6] Whole body bone scintigraphy has been demonstrated to be useful and more sensitive than plain radiographs in the detection of extraosseous calcification. [7],[8] This is a rare case of adult-onset dermatomyositis showing subcutaneous fat calcinosis exclusively.

 
   References Top

1.
Callen JP. Dermatomyositis. Lancet 2000;355:53-7.  Back to cited text no. 1
[PUBMED]    
2.
Shah R, Ellis S. Subcutaneous fat calcinosis in adult-onset dermatomyositis. BMJ Case Rep 2011;2011:pii:bcr0520114268.  Back to cited text no. 2
    
3.
Chander S, Gordon P. Soft tissue and subcutaneous calcification in connective tissue diseases. Curr Opin Rheumatol 2012;24:158-64.  Back to cited text no. 3
    
4.
Ogretmen Z, Akay A, Bicakci C, Bicakci HC. Calcinosis cutis universalis. J Eur Acad Dermatol Venereol 2002;16:621-4.  Back to cited text no. 4
    
5.
Santili C, Akkari M, Waisberg G, Kessler C, Alcantara Td, Delai PL. Calcinosis universalis: A rare diagnosis. J Pediatr Orthop B 2005;14:294-8.  Back to cited text no. 5
    
6.
Abdallah-Lotf M, Grasland A, Vinceneux P, Sigal-Grinberg M. Regression of cutis calcinosis with diltiazem in adult dermatomyositis. Eur J Dermatol 2005;15:102-4.  Back to cited text no. 6
    
7.
Bhattacharya A, Prasad V, Thomas EJ, Singh B, Mittal BR. Tc-99m MDP scintigraphy in a case of idiopathic calcinosis cutis. Clin Nucl Med 2005;30:431-2.  Back to cited text no. 7
    
8.
Agarwal V, Sachdev A, Dabra AK. Case 104: Calcinosis in juvenile dermatomyositis. Radiology 2007;242:307-11.  Back to cited text no. 8
    


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