Calcinosis in Adult-Onset Dermatomyositis: Metastatic or Dystrophic?

Excerpt

An 89-year-old woman with adult-onset dermatomyositis presented with fatigue, abdominal pain, and leg swelling for two weeks. Physical examination revealed a tender, distended abdomen and lower extremities with pitting edema and purpuric lesions suggestive of leukocytoclastic vasculitis. Laboratory investigation revealed an elevated corrected calcium level (12.7 mg/dl), elevated 1,25 dihydroxyvitamin D (120 pg/ml) and parathyroid hormone (PTH) at the upper limits of normal (22 nLEq/ml); PTH-related protein and phosphorus levels were normal. Chest radiography demonstrated extensive subcutaneous and muscular calcifications, most prominent in the shoulders (Fig. 1). Computed tomography of the abdomen showed a 9-cm retroperitoneal mass (Fig. 2), ultimately diagnosed as B-cell lymphoma. The patient passed away in the hospital while awaiting hospice arrangements.

…