[Dystrophic calcinosis cutis and SLE; the bone scan pattern (Case report)]

A 21 years old woman presented with a history of SLE and skin lesions on the arms, trunk, and abdomen. The left gluteal region was ulcerated and painful and occasionally extruded a chalky white material. The patient referred from rheumatology department for osteomyelitis assessment. On physical examination the patient had hard, nontender lesions on the proximal arms, lower abdomen and lower back. She had painful, hyper pigmented bullae, plaques, erosions and ulcer on her hands, arms, thighs, knees and especially left gluteal region. All laboratory results including BUN, Cr, Ca, Ph, LFT, were normal except for ESR which was increased. Left gluteal skin biopsy reveals homogenized and sclerotic collagen in the lower dermis with scattered foci of calcification, consistent with calcinosis cutis. The whole body bone scan shows diffuse extra osseous calcification mainly in the arms, lower trunk and thighs. The X-ray findings revealed multiple foci of calcification in the soft tissue compartment of the arms and lower trunk. Focal areas of increased uptake in the ribs and right humerus secondary to osteoporosis and truma were noticed. Calcinosis cutis is a rare presentation of SLE. It is usually seen in CRF and due to electrolyte impairment. In this report however, a case of SLE is presented with extensive calcinosis but normal renal function and lack of any electrolyte imbalance.