Prabhu Raghunath, Sarma Yashdeep Sinha, Phillip Karan, Sadhu Sakshi
Department of Surgery, Manipal University Kasturba Medical College, Karnataka, India.
Eurasian J Med. 2014 Jun;46(2):131-4. doi: 10.5152/eajm.2014.29.
Idiopathic calcinosis cutis is a condition involving the deposition of calcium salts in the skin and subcutaneous tissue. The disease is a pathological condition of unknown origin and hence is idiopathic. The salt deposition is confined to areas such as the breast and vulva in females and scrotum and penis in males. Diffuse calcification with multiple complications in an adult is a rare entity. Only one such case has been reported in literature. A 59-year-old female presented to us with swelling of the right elbow, multiple calcific nodular lesions all over her fingers approximately 0.5x0.5 cm in size, and ulcers on her left great toe and right thumb with pain for the past two months. The ulcers were 2x2 cm and were observed to be healing without active discharge or signs of inflammation. The elbow was diffusely swollen and tender. Flexion deformity was present at the elbow. X-ray of hand and feet revealed calcinosis of the elbow and interphalangeal joints of the foot and hand. Blood tests revealed elevated C-reactive protein levels of 24 mg/dL, elevated Erythrocyte Sedimentation Rate (ESR) of 52 mm/hr., serum calcium of 9.7 mg/dL and a serum phosphorous of 5 mg/dL. Cultures from the foot ulcer were positive for methicillin-resistant staphylococcus aureus (MRSA). Workup for collagen vascular disease was negative. Histopathology confirmed calcinosis cutis. Treatment involved a conservative approach, including physiotherapy for the flexion deformity, antibiotics for MRSA, analgesics for pain relief and daily dressings. This case demonstrates that if a patient presents with multiple chalky nodular lesions with or without ulceration, pain and discharge involving areas of the upper limb or lower limb, diagnosis of idiopathic calcinosis cutis could be considered as a differential, despite its common confinement to the scrotum, breast, vulva and penis.
特发性皮肤钙化病是一种涉及钙盐在皮肤和皮下组织沉积的病症。该疾病是一种病因不明的病理状况，因此是特发性的。盐沉积局限于女性的乳房和外阴以及男性的阴囊和阴茎等部位。成人出现弥漫性钙化并伴有多种并发症是一种罕见情况。文献中仅报道过一例此类病例。一名59岁女性前来就诊，其右肘肿胀，手指上遍布多个钙化结节性病变，大小约为0.5×0.5厘米，左大脚趾和右拇指有溃疡，且在过去两个月一直疼痛。溃疡大小为2×2厘米，观察到正在愈合，无活动性渗液或炎症迹象。肘部弥漫性肿胀且压痛。肘部存在屈曲畸形。手足X线检查显示肘部以及手足的指间关节有钙化。血液检查显示C反应蛋白水平升高至24毫克/分升，红细胞沉降率（ESR）升高至52毫米/小时，血清钙为9.7毫克/分升，血清磷为5毫克/分升。足部溃疡培养物对耐甲氧西林金黄色葡萄球菌（MRSA）呈阳性。胶原血管病的检查结果为阴性。组织病理学证实为皮肤钙化病。治疗采用保守方法，包括针对屈曲畸形的物理治疗、针对MRSA的抗生素治疗、缓解疼痛的镇痛药以及每日换药。该病例表明，如果患者出现多个灰白色结节性病变，伴有或不伴有溃疡、疼痛和渗液，累及上肢或下肢部位，尽管特发性皮肤钙化病通常局限于阴囊、乳房、外阴和阴茎，但仍可将其作为鉴别诊断考虑。
