Manrique Monica, Escandón Joseph M, Paredes-Gutierrez Juliana, Mantilla-Rivas Esperanza, Nasser Jacob S, Oh Haley S, Duarte-Bateman Daniela, Oh Albert K, Rogers Gary F
Division of Plastic and Reconstructive Surgery, Children's National Hospital, Wash., D.C.
Plast Reconstr Surg Glob Open. 2023 Mar 10;11(3):e4837. doi: 10.1097/GOX.0000000000004837. eCollection 2023 Mar.
Calcinosis cutis is the term used to describe the deposition of calcium compounds within the skin and subcutaneous tissue, which can occur after the administration of intravenous calcium compounds. Its etiology is broad, and the clinical presentation is variable, creating a diagnostic challenge. Although iatrogenic calcinosis cutis is extremely uncommon, awareness and early diagnosis of this entity can reduce the risks of severe complications, including soft tissue damage, restricted joint mobility, and even nerve compression. Clinical suspicion should prompt a thorough review of the medical history and appropriate radiographic studies. Evidence of extensive soft tissue calcification must be present on radiographic imaging to confirm the diagnosis. Iatrogenic calcinosis cutis is managed conservatively, and resolution of symptoms is expected within 2 months of symptom onset. Herein we report the case of an infant with DiGeorge syndrome who developed iatrogenic calcinosis cutis after receiving an intraoperative infusion of calcium gluconate. Our patient presented with right lower extremity swelling, erythema, and warmth over a broad area of the leg centered on the entry point of the venipuncture. This was initially mistaken and managed as cellulitis, but once an accurate diagnosis was made, the symptoms gradually resolved with conservative care and no functional sequelae. We also present the literature on iatrogenic and idiopathic calcinosis cutis in the pediatric population.
皮肤钙化症是用于描述钙化合物在皮肤和皮下组织中沉积的术语,这种情况可在静脉注射钙化合物后发生。其病因广泛,临床表现多样,给诊断带来挑战。尽管医源性皮肤钙化症极为罕见,但对该病症的认识和早期诊断可降低严重并发症的风险,包括软组织损伤、关节活动受限甚至神经受压。临床怀疑应促使对病史进行全面回顾并进行适当的影像学检查。影像学成像上必须有广泛软组织钙化的证据才能确诊。医源性皮肤钙化症采用保守治疗,症状预计在症状出现后2个月内缓解。在此,我们报告一例患有22q11.2微缺失综合征(DiGeorge综合征)的婴儿,其在术中输注葡萄糖酸钙后发生医源性皮肤钙化症。我们的患者表现为右下肢肿胀、红斑,以静脉穿刺点为中心的腿部大片区域发热。最初误诊为蜂窝织炎并进行了相应治疗,但一旦做出准确诊断,症状经保守治疗逐渐缓解,未留下功能后遗症。我们还介绍了儿科人群中医源性和特发性皮肤钙化症的相关文献。