Calcinosis Cutis Following Liver Transplantation in a Pediatric Patient

Abstract

We report the occurrence of calcinosis cutis in a 3-year-old girl after liver transplantation. The cutaneous lesions consisted of 5 mm white papules on an erythematous base in linear and rosette configurations that developed in the abdominal and lumbar areas 10 days after transplantation. The patient had received calcium chloride solution intravenously during surgery. We excluded other causes of ectopic calcification such as hyperparathyroidism, renal failure, and extravasation of calcium solution. We discuss the etiology of calcinosis cutis after liver transplantation. This sequence of events has not been previously described in pediatric patients.

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“…Therefore, calcification can be metastatic, or local trauma because of subcutaneous injections can be precipitate calcification (dystrophic). [17][18][19] In our report, we had 2 cases with calcinosis cutis, and they both occurred on the hands of these patients. In both cases, serum calcium levels were within normal limits.…”

“…Four different types of calcinosis cutis can be identified: dystrophic, metastatic, idiopathic, and iatrogenic. 17,18 Dystrophic calcinosis is the most common type and occurs in previously damaged tissue. Metastatic calcinosis occurs in normal tissues as a result of a disturbance in systemic calcium homeostasis, such as renal failure.…”

“…The pathogenesis of calcinosis in liver transplant recipients is uncertain, with previous reports suggesting that these calcifications could be either dystrophic or metastatic. 18,19 Liver transplant recipients also are open to severe metabolic problems, including calcium homeostasis and renal failure around the time of surgery and during the postoperative period. Therefore, calcification can be metastatic, or local trauma because of subcutaneous injections can be precipitate calcification (dystrophic).…”

Uncommon Localization of Calcinosis Cutis after Liver Transplantation

“…Three groups of calcinosis cutis have been described: (i) calcinosis with abnormalities of the calcium-phosphorus metabolism, (ii) dystrophic calcinosis associated with underlying tissular alterations, normal serum calcium and phosphorus levels, (iii) idiopathic calcinosis if there is no other associated abnormality [1,2] . After liver transplantation, soft tissue calcium deposits are observed, but calcinosis cutis was rarely described [3][4][5][6][7] . We report the case of a liver graft recipient who developed an uncommon clinical picture of calcinosis cutis, which was associated with intrahepatic calcifi cations and successfully treated with disodium etidronate.…”

“…Numerous cases of calcinosis cutis have been reported after solid organ transplantation [6][7][8] . After liver transplantation, soft tissue calcifi cations have been described in 47-84% of cases, most frequently in the lungs, blood vessels, kidneys, pancreas, liver graft, adrenal glands, colon and gastric mucosa.…”