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Subepidermal calcified nodule in a 7-month-old boy.Skinmed.
2007 Jan-Feb;6(1):44-5
A 7-month-old
healthy white boy presented for evaluation of a papule on his right
ear. His mother reported a small cut-like lesion at this site
shortly after birth that had gradually grown over time. The patient
was born full term via repeat cesarean section. On physical
examination, located on the right superior helix, there was a 5-6
mm, pink, firm papule with a rough scaly surface and peripheral
erythema (Figure 1). The lesion was shave excised and sent for
histologic analysis. Microscopic examination revealed a defect of
the epidermis with underlying fibrin deposits (Figure 2). Subjacent
to the ulcer, there was chondroid tissue, granulation tissue with
prominent vascularity, and an extensive amount of amorphous
calcified material throughout the dermis extending to the base of
the specimen (Figure 3). The clinical and pathologic findings were
consistent with a subepidermal calcified nodule (SCN), an uncommon
idiopathic calcinosis. The lesion was surgically removed with good
results.
Calcinosis cutis
of the fingertip associated with Raynaud's phenomenon.
J Dermatol. 2006
Dec;33(12):884-6.
Cutaneous
calcification may be divided into four major categories: (i)
dystrophic; (ii) metastatic; (iii) idiopathic; and (iv) iatrogenic.
Dystrophic calcification is the most common type of calcinosis cutis
and is associated with a variety of diseases. It most notably occurs
in connective tissue diseases. Diffuse and limited cutaneous
systemic sclerosis is an example of connective tissue diseases that
frequently show calcinosis. We experienced a case of fingertip
calcinosis cutis associated with Raynaud's phenomenon. The patient
had no previous trauma, skin lesion or systemic connective tissue
disease. We propose that calcinosis cutis of the fingertip may
result from chronic ischemic injury caused by Raynaud's phenomenon.
Calcinosis cutis:
a complication of intravenous administration of calcium glucanate.J
Cutan Pathol. 2006 Sep;33 Suppl 2:60-2
Calcinosis cutis, the deposition of calcium in the dermis, can be
dystrophic, metastatic, iatrogenic, or idiopathic. Here, we describe
a case of iatrogenic calcinosis cutis secondary to extravasation of
an intravenous calcium-containing solution in a child. We also
review the literature regarding the pathogenic mechanisms involved
in the development of calcinosis cutis after extravasation injuries.
While iatrogenic calcinosis cutis is generally a benign entity, it
is important to recognize its unique clinical and histopathologic
presentation to avoid complications from misdiagnosis.
Cutaneous
calcification in patients with end-stage renal disease: a regulated
process associated with in situ osteopontin expression.
Arch Dermatol. 2006
Jul;142(7):900-6
BACKGROUND:
Cutaneous calcification, or calcinosis cutis (CC), is found in
approximately 1% of patients with end-stage renal disease (ESRD)
undergoing chronic dialysis. While the pathogenesis is not well
understood, it may be similar to those for medial and intimal
vascular calcifications, which are actively regulated processes.
OBSERVATION: In a retrospective study of 9 patients, the role of an
active calcification process leading to CC was assessed by the
immunohistochemical detection of osteopontin, which is a regulator
of osseous and extra-osseous calcification processes. Calcinosis
cutis was associated with female sex, vascular comorbidity,
inconstant secondary hyperparathyroidism, and elevated levels of
plasma calcium-phosphorus product. Six patients had a favorable
outcome after the lowering of plasma calcium levels during dialysis
or after parathyroidectomy. CONCLUSIONS: Calcinosis of the vascular
media of subcutaneous vessels was the most common histologic feature
and was always associated with osteopontin staining, suggesting that
CC is a regulated process. Moreover, to our knowledge, extravascular
staining of osteopontin in sweat glands, nerves, and macrophages was
demonstrated for the first time in this study
Calcinosis cutis
universalis in a patient with systemic lupus erythematosus.Clin
Rheumatol. 2006 Feb;25(1):70-4. Epub 2005 May 18
Deposition
of calcium salts in the skin and subcutaneous tissue occurs in a
variety of rheumatic diseases, being most commonly associated with
scleroderma, CREST (calcinosis, Raynaud's phenomenon, esophageal
dysfunction, sclerodactyly, and telangiectasia), dermatomyositis,
and overlap syndromes but is a rare complication of systemic lupus
erythematosus (SLE). Calcinosis is classified into four subsets:
dystrophic, metastatic, idiopathic, or calciphylaxis/iatrogenic. The
pathophysiology of calcinosis cutis remains unclear. Our patient
developed extensive areas of calcifications in the trunk and
extremities (calcinosis universalis) 8 years after SLE diagnosis,
which would correspond to a form of dystrophic calcification. No
response was observed after treatment with oral diltiazem for 3
months. We review the literature on the pathogenesis and prevalence
of calcinosis universalis in SLE.
Extensive skin
calcifications in an infant with chronic renal failure: metastatic
calcinosis cutis.Pediatr
Dermatol. 2006 May-Jun;23(3):235-8.
Calcinosis
cutis, one of the rare manifestations of systemic calcinosis, is
characterized by the deposition of calcium and phosphate salts in
the skin. Metastatic calcinosis, usually a late complication of
chronic renal failure, arises from increased calcium or phosphate
levels in the serum or both. Both sexes and all ages may be
affected; however, cutaneous involvement is uncommon, particularly
in children. We present the youngest patient, to our knowledge, with
end-stage renal disease and cutaneous metastatic calcification
resulting from secondary hyperparathyroidism. A 2-month-old infant
presented to the pediatric service with anuria and uremia. A renal
biopsy specimen showed chronic tubulo-interstitial nephritis.
Indurated, firm, tender reddish papules were localized to both lower
limbs, and extensive irregular nodules and plaques with ulceration
and white stony contents were localized to the right upper limb.
Topical antibiotic ointment was applied to the skin lesions to
prevent secondary infection. However, acute peritonitis developed
during peritoneal dialysis, and death occurred as a result of
sepsis.
Iatrogenic calcinosis
cutis--a rare differential diagnosis of soft-tissue infection in a
neonate: a case report.J
Orthop Surg (Hong Kong). 2005 Aug;13(2):195-8
This case
report describes a rare differential diagnosis of soft-tissue
infection in a neonate. Fever, pain, inflammation, and acute
tenderness in the limb of a neonate signify acute infection or
osteomyelitis unless proved otherwise. Iatrogenic calcinosis cutis
presents with similar symptoms and signs; its diagnosis may be
easily confused with an infective condition by an unwary orthopaedic
surgeon. This report aimed to raise doctors' awareness on the
presentation, aetiopathogenesis, and course of the relatively rare
iatrogenic calcinosis cutis.
Cutaneous
calcification following liver transplantation.Clin
Exp Dermatol. 2005 Sep;30(5):484-6
Ectopic
calcification following liver transplantation has been reported to
occur in various internal organs but there have been few reports of
skin involvement. The pathogenesis is uncertain with previous
reports suggesting that the calcifications could be either
dystrophic or metastatic. The large amount of intravenous calcium
needed to correct hypocalcaemia secondary to blood product
transfusion is thought to play a central role. We report a case of
calcinosis cutis developing after liver transplantation in a
22-year-old woman at sites where no intravenous calcium had been
administered. In previously published cases serum calcium and
phosphate levels were reported as normal. In our case serum calcium
levels were also within or below normal limits with the exception of
a transient rise in the immediate post-operative period. Our case
supports earlier hypotheses that short-lived and often undetected
elevations in the calcium-phosphate product are implicated in this
condition.
Calcinosis
cutis following trauma.Pediatr
Dermatol. 2005 May-Jun;22(3):227-9
We report an
8-year-old boy who developed dystrophic calcinosis cutis that
occurred following trauma. Multiple abrasions were observed in the
inguinal folds after a soccer game. Subsequently, multiple papules
with soft centers and white particles appeared in the same area. A
biopsy specimen showed calcinosis cutis with transepidermal
elimination of calcium. The causes of the underlying tissue damage
associated with dystrophic calcinosis are discussed.
Calcinosis of the
cutis and subcutis: an unusual nonimmunologic adverse reaction to
subcutaneous injections of low-molecular-weight calcium-containing
heparins.
J Am Acad Dermatol. 2004 Feb;50(2):210-4
BACKGROUND:
Local side effects at the injection sites of low-molecular-weight
heparins are rare and can be of immunologic or nonimmunologic
origin. Calcinosis cutis is a rare disorder and occurs in various
circumstances. In patients with chronic renal failure the risk of
pathologic calcifications is raised due to elevated
calcium-phosphorus products. OBJECTIVE: Five patients suffering from
renal failure developed remarkable cutaneous and subcutaneous
nodules or plaques following subcutaneous nadroparin-calcium
injections. Our aim was to evaluate the morphology and precipitation
factors of these calcifications and to discuss immunological and
nonimmunological differential diagnoses. METHODS: Histological
examination, spectroscopic analysis, ultrasonography, allergy
testing and reexposition testing including non-calcium heparins were
performed. RESULTS: Histology using the van Kossa staining technique
revealed calcinosis of the dermis and subcutis. Ultrasonography
showed focal subcutaneous calcifications. In all patients the
calcium-phosphorus products were elevated. CONCLUSION: Clinicians
should be aware that patients with renal failure and elevated
calcium-phosphorus products may be at risk of developing calcinosis
cutis at calcium-containing heparin injection sites. As a
consequence, we propose the use of non-calcium heparins in these
patients.
Calciphylaxis in chronic, non-dialysis-dependent renal disease.BMC
Nephrol. 2003 Sep 29;4:8
BACKGROUND:
Calciphylaxis cutis is characterized by media calcification of
arteries and, most prominently, of cutaneous and subcutaneous
arterioles occurring in renal insufficiency patients. CASE REPORT: A
53-year-old woman with chronic cardiac and renal failure complained
of painful crural, non-varicosis ulcers. She was hospitalized in an
immobilized condition due to both the crural ulcerations and the
existing heart-failure state (NYHA III-IV) having pleural and
pericardial effusions, atrial fibrillation and weight loss of 30 kg
over the past year. Despite normalization of calcium-phosphorus
balance and improvement of renal function, the clinical course of
crural ulcerations deteriorated during the following 3 months. After
failure of surgical debridements, multiple courses of sterile-maggot
therapy were introduced at a late stage to stabilize the wounds. The
patient died of recurrent wound infections and sepsis paralleled by
exacerbations of renal malfunction. CONCLUSIONS: The role of renal
disease in vascular complications is discussed. Sterile-maggot
debridement may constitute a therapy for the ulcerated calciphylaxis
at an earlier stage, i.e. when first ulcerations appear.
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