Calcinosis Universalis of the Elbow: A Rare Case with Classical Presentation

Abstract

Juvenile Dermatomyositis (JDM) is a rare autoimmune disease in children and adolescents. In these patients calcinosis might be the most characteristic symptom. However there are only few reported cases of intramuscular calcinosis in Dermatomyositis. We report a case of calcinosis universalis (CU) of the elbow in JDM successfully treated with broaching. The patient, a 24-year-old woman, suffered from a long history of JDM. On examination she presented with a fistula lateral to the olecranon and pain of the right elbow joint. Plain X-rays displayed a diffuse pattern of multiple periarticular, subcutaneous, and intramuscular calcifications. The patient underwent surgery for histological and microbiological sampling as well as broaching. Intraoperatively sinus formation and subfascial hard calcium deposition were found. Due to the risk of collateral tissue damage, incomplete broaching was performed. A local infection with Staphylococcus was diagnosed and treated with antibiotics. On six-week and 30-month follow-up the patient was free of pain and had very good function. Calcifications on standard radiographs had almost resolved entirely. This case report gives a summary on calcinosis in Dermatomyositis and adds a new case of recalcitrant CU to the literature. Broaching surgery proved to be a reliable treatment option in symptomatic calcinosis.

Profile of Pediatric Idiopathic Inflammatory Myopathies from a Tertiary Care Center of Eastern India

“…The isolated cutaneous sinus tract was noted in one patient over the right clavicle. Association of such sinus tract with JDM is rarely reported [23]. In the present study populations, none had lipodystrophy.…”

“…However, one of the index patients had early calcinosis (Case 8). Another had Calcinosis universalis (Case 5), which is relatively uncommon in younger children and only a few cases have been reported in older children and adults [18][19][20][21][22][23]. The isolated cutaneous sinus tract was noted in one patient over the right clavicle.…”