Calcinosis universalis in systemic sclerosis

The patient, a 46‐year‐old woman with a history of systemic sclerosis, interstitial lung disease, and dystrophic calcinosis cutis presented to the emergency department complaining of right thigh pain. Physical examination was notable for a large erythematous, tender, indurated circular area in the medial thigh with many large calcified nodules throughout her thighs. Incision and drainage yielded a small amount of purulent chalky fluid. The patient received antibiotics and was discharged home. Over 5 years, the patient had recurrent soft tissue infections with progressive calcinosis. Her basic metabolic panel was within normal limits (including calcium and phosphorus levels). Computed tomography showed extensive calcification throughout the subcutaneous tissues of the pelvis and bilateral thighs. Some of the calcinosis extended into the intermuscular fascial planes of the adductor and posterior compartment musculature of the bilateral thighs. The patient received nifedipine, mycophenolic acid, rituximab, colchicine, and sodium thiosulfate (topical, intralesional, and intravenous), but her calcinosis continued to progress. Calcinosis is a debilitating condition that occurs in 40% of patients with systemic sclerosis. A long disease duration is associated with progressive calcinosis (1). Thus far, there are no effective treatment options for calcinosis.