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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 23  |  Issue : 1  |  Page : 71-73

Idiopathic linear calcinosis cutis


Department of Dermatology, SMS Medical College, Jaipur, Rajasthan, India

Date of Submission19-Aug-2020
Date of Acceptance21-Oct-2021
Date of Web Publication31-Dec-2021

Correspondence Address:
Vijay Paliwal
92/208, Mansarovar, Jaipur - 302 020, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.ijpd_134_20

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  Abstract 


Linear calcinosis cutis is a very rare disorder; reported in association with lichen sclerosus etatrophicus, scleroderma, after intravenous infusion of calcium and acute monocytic leukemia. In available literature, idiopathic zosteriform calcinosis cutis is yet to be described. An 8-year-old child presented with spontaneous painful, slowly progressive, linear band-like nodules over the right half of the chest and back of the trunk. Histopathology with special stains was done to confirm the diagnosis. The patient was treated with diltiazem and responded well. We report a case of idiopathic zosteriform calcinosis cutis because of unusual presentation and rarity of the disorder.

Keywords: Diltiazem, linear calcinosis cutis, zoasteriform


How to cite this article:
Gupta N, Paliwal V, Bhargava P, Mathur DK. Idiopathic linear calcinosis cutis. Indian J Paediatr Dermatol 2022;23:71-3

How to cite this URL:
Gupta N, Paliwal V, Bhargava P, Mathur DK. Idiopathic linear calcinosis cutis. Indian J Paediatr Dermatol [serial online] 2022 [cited 2022 Jan 16];23:71-3. Available from: https://www.ijpd.in/text.asp?2022/23/1/71/334665




  Introduction Top


Calcinosis cutis is a condition in which calcium salts deposit in the skin and subcutaneous tissue. It is an uncommon disorder, characterized by tender, hard skin-colored dermal nodules. Four distinct categories described dystrophic, metastatic, iatrogenic, and idiopathic. Morphological variants include nodular, plaque, tumoral, and linear occurring localized or generalized in distribution.[1]

Linear calcinosis cutis is a very rare entity; reported in association with lichen sclerosus et atrophicus (LSA), scleroderma, after intravenous infusion of calcium and acute monocytic leukemia.[2],[3],[4],[5],[6]

The zosteriform calcinosis cutis is described in association with LSA. In best of our knowledge, idiopathic zosteriform calcinosis cutis is yet to be described. After taking consent from the parents, we report a case of idiopathic zosteriform cutis because of rarity of the disorder.


  Case Report Top


A 8-year-old boy presented in the skin outpatient department with complaint of linear painful nodules over the right half of the chest of 2–3 months' duration. According to his parents, these nodules seemed to be started as brownish discolored slightly raised lesions over the right half of the chest. Over a period of 2–3 months, these lesions increase in size and progressed linearly from the chest to back of the trunk up to midline. Some of these lesions discharged whitish chalk-like material. Thereafter, these lesions more or less remained unchanged. There was no history of trauma, any kind of injection over the area, muscle weakness, hardening or whitish discoloration of skin, and any congenital anomaly over the affected area.

On examination, there were multiple brown to skin colored, tender, hard to firm dermal nodules and hyperpigmented and atrophic scars distributed linearly over the right pectoral, infraaxillary, adjoining scapular region in the distribution of the 4th spinal nerve [Figure 1]. The surrounding and intervening skin was normal in color and consistency. Other general physical and systemic examinations were unremarkable.
Figure 1: Figure showing multiple linearly arranged brownish colored nodules and atrophic scars over right pectoral, infra axillary and infra scapular area

Click here to view


Routine laboratory investigations including complete blood count, PBF, and erythrocyte sedimentation rate were within the normal limits. Mantoux test was measured 3 mm after 72 h and considered as negative. Special investigations including ANA, DNA, Anti-Jo 1, Anti LA, Anti Scl 70, and anti-centromere antibody were negative. Both serum and 24 h urinary calcium and phosphorus were within the normal limits. Other biochemical investigations for kidney, liver, and parathyroid were within the normal limits.

Skiagram of the chest was otherwise normal except multiple calcified linearly arranged opacities in the soft tissue of the chest wall.

Histopathology revealed multiple dense area of calcification in entire dermis and subcutaneous tissue without any inflammatory reaction. In addition, there was marked atrophy of overlying epidermis. The connective tissue and ground substances were unremarkable [Figure 2].
Figure 2: Figure showing diffuse calcium deposits in dermis

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On the basis of clinical, laboratory investigation, and histopathology, a diagnosis of linear calcinosis cutis was made.


  Discussion Top


Calcinosis cutis is classified into four categories: dystrophic, metastatic, iatrogenic, and idiopatathic. The linear calcinosis cutis is usually occurs secondary to underlying disorder. Dystrophic linear calcinosis cutis is the most common; it occur in previously damaged tissues secondary to limited or diffuse scleroderma, panniculittis, cutaneous neoplasm, trauma, and other inflammatory disorders. Linear calcinosis cutis reported in association with morphea, intravenous calcium gluconate therapy, and acute monocytic leukemia. All above-mentioned categories of calcinosis occur with normal serum and urinary calcium level.

Metastatic calcification is associated with raised serum calcium level; however, both serum and urinary calcium levels were normal in our case. A linear pattern of calcium deposition has previously been reported as a result of calcium gluconate infusions. These linear deposits occurred in the vein distal to the infusion site and presented 2 h to 24 days after the calcium infusion.[3],[5] This is not true in our case as he never received calcium infusion(s).

Pathophysiology of calcinosis is not much understood, few studies indicate that it occurs secondary to trauma or tissue damage,[2],[5] it is not true in this case as he never had any trauma or pathology over the affected area that can lead to tissue damage. The pathophysiology in our case remained an enigma; it would have been developed due to some localized changes in the composition of dermal tissues, particularly collagen which provided niche to calcium deposition.

The treatment of calcinosis cutis is difficult it includes surgical excision or carbon dioxide laser assisted excision, bisphosphonates, diltiazem, probenecid, aluminum hydroxide, and colchicin.[7]


  Conclusion Top


Zosteriform calcinosis cutis has been described with scleroderma, calcium infusion, acute monocytic leukemia, and panniculitis. Idiopathic calcinosis cutis is yet to be described in literature. In best of our knowledge, probably, this is the first case of idiopathic linear calcinosis cutis to be report. The pathophysiology of calcinosis in this case remained an enigma, it requires further studies.

Practice points

  1. Calcinosis cutis is classified into four categories: dystrophic, metastatic, iatrogenic, and idiopathic
  2. Dystrophic linear calcinosis cutis is the most common; occur in previously damaged tissues with normal serum and urinary calcium level while metastatic calcification occurs over normal tissue and it is associated with raised serum calcium level
  3. Linear calcinosis cutis occurs in association with morphea, intravenous calcium gluconate therapy, LSA, panniculittis, cutaneous neoplasm, trauma, acute monocytic leukemia, and other inflammatory disorders.


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sarkany RP, Breathnach SM, Morris AM, Weishmann K, Flynn PD. Metabolic and nutrional disorders. In: Burns T, Breathnach S, Cox N, Grifiths C, editors. Rooks Textbook of Dermatology. 8th ed., Vol. 59. West Sussex: Wiley-Blackwell; 2010. p. 68-70.  Back to cited text no. 1
    
2.
Jinnin M, Ihn H, Asano Y, Yamane K, Yazawa N, Tamaki K. A case of linear scleroderma with muscle calcification. Br J Dermatol 2002;146:1084-6.  Back to cited text no. 2
    
3.
Cheng PS, Lai FJ. Sporotrichoid-like calcinosis cutis and calcifications in vessel walls and eccrine sweat glands following intravenous infusion of calcium gluconate. Br J Dermatol 2012;166:892-4.  Back to cited text no. 3
    
4.
Lau K, Willig RP, Hiort O, Hoeger.PH. Linear skin atrophy preceding calcinosis cutis in pseudo-hypoparathyroidism. Clin Exp Dermatol 2012;1:1-3.  Back to cited text no. 4
    
5.
Ahn SK, Kim KT, Lee SH, Hwang SM, Choi EH, Choi S. The efficacy of treatment with triamcinolone acetonide in calcinosis cutis following extravasation of calcium gluconate: A preliminary study. Pediatr Dermatol 1997;14:103-9.  Back to cited text no. 5
    
6.
Satter EK, Maari CH, Morel KD, Eichenfield LF, Cunningham BB, Friedlander SF, et al. Disseminated linear calcinosis cutis associated with the Koebner phenomenon in an infant with congenital acute monocytic leukaemia. Br J Dermatol 2004;150:753-6.  Back to cited text no. 6
    
7.
Singh J, Paliwal VK, Bhargava P, Mathur DK. Idiopathic calcinosis cutis universalis treated successfully with oral diltiazem-A case report. Pediatr Dermatol 2017;34:e241-4.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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