Baylor University Medical Center Proceedings July 2017 - 369

(1). CT is typically
used to evaluate the
disease burden for
surgical planning.
Another key feature
is absence of erosion
and destruction of
nearby bone (1).
Laboratory studies
should be performed
to rule out other disease processes before
a deﬁnitive diagnosis
of calcinosis cutis is
made, as it is a diagnosis of exclusion (1,
4). If the diagnosis
remains uncertain,
biopsy can be perFigure 1. Extensive ulcerated calcific deposits in (a) the left third digit and (b) the left axilla.
formed (1).
Secondary calcinosis cutis is usually treated with medical management of
Metastatic calcinosis cutis usually presents with benign nodthe underlying cause. When medical therapy has failed, subules at periarticular sites (3). However, symptoms such as pain,
total parathyroidectomy is indicated. Renal transplant is also
joint stiﬀness, nerve compression, inﬂammation, ﬁstula formaan option in secondary hyperparathyroidism, as it resolves the
tion, and infection may be present at the time of diagnosis (1, 2).
underlying process (5), but may not be an option for tertiary
Physical exam ﬁndings may be signiﬁcant for decreased range of
motion or pain at the aﬀected site. Our patient presented with
hyperparathyroidism, as in our case. Surgical debridement of
advanced disease with large, calciﬁc ulcerated skin lesions. In
the lesions is indicated for recurrent infection, ulceration, and
metastatic calcinosis cutis, calciﬁcation is typically seen in blood
pain or impairment (1). Treatment includes restricting calcium
vessels, kidneys, lungs, and gastric mucosa as well (3). Radioand phosphorus intake (to <700 mg/day) in the diet and the use
graphic evidence of the disease is the primary modality of diof phosphate binders (1, 2, 6, 7). Other medical therapies such
agnosis, along with supporting laboratory data. The appearance
as vinpocetine, sodium thiosulfate, and intravenous pamidroon computed tomography (CT) is characterized as cystic loculi
nate have been used with variable success (1). In our patient,
with ﬂuid and calcium layering known as the sedimentation sign
sodium thiosulfate was used. This drug was originally used to
treat cyanide poisoning, but has shown eﬃcacy in several cases
of calcinosis cutis (2, 6).
a

1.
2.

4.
5.
6.

Figure 2. CT scan showing extensive, lobulated soft tissue calcification about the
left shoulder girdle and left chest wall in aggregate measuring up to 16.1 cm anteroposteriorly × 17.6 cm transversely × 11.5 cm in the craniocaudal dimension.

July 2017

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Metastatic calcinosis cutis in end-stage renal disease

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Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings July 2017