Fig. 1.

Clinical manifestations of SMS in the family. a A pacemaker generator, sternotomy wires, and a prosthetic mitral valve are present. b Calcification of the abdominal aorta is observed and the lumbar vertebral bodies show low bone mineral density. c Joint deformities are evident due to metacarpophalangeal joint subluxation. d Calcification is seen at the insertion of the Achilles tendon and the plantar fascia. e Toenails are hypoplastic and subcutaneous calcium deposition is evident over the fourth toe