Correspondence Address:
Dr. Muhammed Jasim Abdul Jalal
Olive Health Care, Vatanapally, Thrissur 680614, Kerala
India

Full Text



Dear Editor,

Calcinosis is a common finding in juvenile dermatomyositis (JDM), which usually manifests within a few years of diagnosis. Approximately 30%–70% of JDM cases show this clinical feature and this can be more debilitating than the myopathy itself.[1] Although unusual, there are few cases of soft-tissue calcifications reported in adults also.[2] The sites that have been subject to friction, stress, or trauma such as elbows and knees are predominantly involved. The most common site is subcutaneous tissue, but can also be seen in the skin, fascia, or muscle.[3]

A 54-year-old man (Indian) presented with a confluent rash over the face and trunk. He initially noted the rash after the consumption of fish. It was itchy and persisted for months. Later, he developed weakness in his muscles, predominantly the proximal group. He found it difficult to get up from the squat and ascend the stairs. He also had a history of recent breathlessness which was diagnosed as pneumonia and treated.

A general examination showed rashes over his face, trunk, and dorsum of his hands. There was no thyromegaly. He was hemodynamically stable with a blood pressure of 120/90 mm Hg and a heart rate of 88/min. Auscultation of lung fields revealed fine interstitial crepitations bilaterally. Heart sounds were regular without any murmurs or bruit. The abdominal examination did not show hepatosplenomegaly. He did not have any neurological localizing signs. Deep tendon reflexes were preserved with flexor plantar bilaterally. There was significant proximal muscle weakness in the upper limbs and lower limbs, and his muscles were tender to touch. Fundus examination did not reveal any hemorrhages/exudates.

Investigations revealed elevated serum creatine kinase levels and muscle enzymes. Anti-Jo-1 antibodies, rheumatoid factor (RF), and anti-nuclear antibody (ANA) profile were negative. He was started on azathioprine on a clinical background of dermatomyositis, to which he poorly responded. He also had multiple joint pains.

The overall clinical picture was suggestive of dermatomyositis and the diagnosis was confirmed with a muscle biopsy, which showed focal areas of necrosis surrounded by neutrophils and lymphocytes.

Radiology of the pelvis regarding joint pain evaluation showed extensive soft-tissue calcification [Figure 1] and [Figure 2], which is not commonly seen in dermatomyositis. He was initiated on methotrexate in addition to steroids and is stable clinically.{Figure 1} {Figure 2}

Financial support and sponsorship

Not applicable.

Conflicts of interest.

There are no conflicts of interest.

References