Calcinosis cutis following liver transplantation: a complication of intravenous calcium administration

Calcinosis cutis may be a complication of administration of intravenous calcium solutions. We report four patients who developed calcinosis cutis following orthotopic liver transplantation, all of whom had received calcium chloride solutions intravenously during surgery. There was no evidence of extravasation of the solutions. A gradual improvement of the lesions was seen in the subsequent months. This complication of intravenous calcium infusions is probably related to the large amounts of blood-derived products and of calcium salts administered during surgery.     

Calcinosis cutis following the administration of intravenous calcium therapy

Calcinosis cutis, the cutaneous deposition of calcium salts in the dermis, can occur through a variety of pathogenetic mechanisms, and can be associated with both normal and elevated calcium levels. Iatrogenic causes of calcinosis cutis include extravasation of intravenously administered calcium chloride or calcium gluconate, and traumatic deposition of calcium in the skin, subsequent to electromyography or electroencephalography. We report two cases of calcinosis cutis following intravenous infusion of a calcium-containing salt.     

Calcinosis cutis following extravasation of calcium chloride

A 27-year-old woman with hypoparathyroidism developed multiple firm white-yellow papules along the path of an infiltrated calcium chloride intravenous infusion. A biopsy specimen obtained ten days after the extravasation revealed an urticarial reaction. A subsequent biopsy specimen, obtained 25 days after the extravasation, showed diffuse dermal calcification, confirmed by roentgenographic analysis, with incipient transepidermal elimination. A biopsy specimen obtained 40 days after the extravasation was consistent with an elimination reaction. An increase in mast cells was not noted. Electron microscopy showed mineral deposits along collagen fibrils without significant collagenous degeneration. In this report we describe a complication of intravenous calcium chloride infusion.     

皮肤钙质沉着症1例

患者,男,56岁,农民因左面颊皮疹15年,渐增大,至我科就诊。患者15年前无明显诱因左面颊出现一针尖大黑点,不痛不痒,缓慢增长。10年前皮疹增至小米粒大,并由黑色逐渐变为黄白色。5年前皮疹增至绿豆大,稍高出皮面,夏天出汗多时有轻痒。1年前来我科就诊时皮疹面积约20ｃｍ×25ｃｍ,     

Calcinosis cutis

A 22-year-old male patient presented with multiple swellings over elbows and knees and a sinus over the right elbow discharging chalky white material. Skin biopsy of the swelling demonstrated calcium deposition in dermis and subcutis. There was no evidence of connective tissue disorder or abnormal mineral metabolism. Hence it was concluded as idiopathic calcinosis cutis and is reported for its interesting presentation.     

Calcinosis cutis following contact with calcium chloride solution

Calcinosis cutis is the deposition of insoluble calcium in the cutaneous tissue. Calcinosis cutis can be classified as metastatic, dystrophic, idiopathic or exogenous. We report a 48‐year‐old white man who was dismantling a portable ice skating rink when calcium chloride solution from the pipes spilt onto his clothing. Several days later, he started to develop mildly pruritic erythematous papules, some studded with white deposits and some with umbilication over the exposed areas corresponding to the spillage of the calcium chloride solution. Histological features revealed interstitial fibrohistiocytic reaction with calcium‐encrusted degenerated collagen bundles in the dermis which was further confirmed by von Kossa stain. He was commenced on topical corticosteroid cream twice daily and the lesions cleared completely between 6 to 10 weeks.     

Calcinosis cutis universalis

We report the case of a 49-year-old female who complained of hardening of the skin, with onset about 1.5 years before presentation. The laboratory data showed normal biochemistry profile. Routine haematochemical examinations showed slight anaemia, an increased erythrocyte sedimentation rate and negative rheumatological markers. Calcium excretion in a 24-h urine sample was normal, but the phosphate excretion was slightly low. The clinical diagnosis was verified by soft tissue ultrasound examination showing subcutaneous calcifications. X-ray examination of bones evidenced no abnormal calcification. Mammography revealed deep seated bilateral reticular calcifications, even in the axillary region. Histological examination showed calcinosis cutis. On these grounds, the diagnosis of idiopathic universal calcinosis cutis was made. The authors describe the clinical and histological picture and discuss the laboratory findings.     

Calcinosis cutis: critical review

The most widely accepted classification of calcinosis cutis is reviewed and several aspects of it are examined. The main point of our criticism is that entities from different groups overlap. Also, the classification mixes etiopathogenic criteria with morphological or semiologic ones. Moreover, the role of the dermatopathologist is limited many times, since only generic information under the diagnosis "calcinosis cutis" is given to the clinician. Taking these into account, we introduce a possible morphological classification of calcinosis cutis, based on the pattern of the cutaneous deposits.     

Calcinosis cutis following trauma

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 cutis: a rare feature of adult dermatomyositis

Dermatomyositis is an idiopathic inflammatory myopathy with characteristic cutaneous manifestations. We describe a case of a 55-year-old woman with dermatomyositis who presented with dystrophic calcinosis resistant to medical treatment.     

Calcinosis cutis universalis und Poikilodermie

Zusammenfassung Calcinosis cutis universalis und Poikilodermie wurden nebeneinander bei einer bandförmigen Sklerodermie und bei einer Dermatomyositis gesehen. Es handelt sich um atrophische Endzustände bei verschiedenartigen Krankheiten, nicht um selbständige Krankheitseinheiten.