Ureteral calcinosis in juvenile dermatomyositis: successful precocious surgical management

Abstract

We report a successful surgical intervention to repair bilateral ureteral strictures in a child with juvenile dermatomyositis (JDM) and ureteral calcinosis. This is the fourth reported case in medical literature. A 9-year-old-girl with severe JDM, a rare connective tissue disease characterized by skin and muscles vasculitis, was under immunosuppressive therapy. In the course of the disease, she presented recurrent urinary tract infections. Bilateral ureteral dilation was detected by ultrasound (US) and intravenous pyelogram (IVP). CT scan showed bilateral ureteral calculus. Ureteroscopy revealed bilateral ureteral calcinosis, confirmed by histopathological analysis. Bilateral double-J stents were placed, resulting in transient improvement of ureteral dilation and infection, but only the surgical removal of abnormal ureteral portions was successful. In conclusion, endourological approach is recommended for diagnosis of urinary tract involvement by JDM because radiological evaluation can be misleading. The immunosuppressive treatment and the resection of damaged ureteral segments have allowed the control of urinary complications.

Infections au cours des polymyosites et des dermatomyosites

“…Si les calcinoses siègent, en règle générale, au niveau des tissus cutanés et sous-cutanés, leurs localisations peuvent aussi être extracutanées. De fait, l'analyse de la littérature Medline (1966-2008) nous a permis de recenser 3 observations de patients atteints de dermatomyosites ayant des épisodes d'infections urinaires itératifs avec dilatation urétérale bilatérale compliquant une calcinose urétérale ; l'évo-lution a été favorable après résection des calcinoses urétérales [62][63][64].…”