Calcifying panniculitis following subcutaneous injections of nadroparin-calcium in a patient with osteomalacia.
Calcifying panniculitis is a rare form of calcinosis cutis belonging to the spectrum of calciphylaxis that has almost invariably been described in patients with severe renal disturbances. We report a patient with osteomalacia without chronic renal failure, who developed calcifying panniculitis following subcutaneous administration of nadroparin-calcium. Light microscopy studies of biopsy specimens revealed multiple foci of microcalcification within the adipose lobules, in the interadipocyte spaces, in connective tissue septa and in the media of small arteries in the subcutis. The patient had an elevated level of intact parathyroid hormone, whereas the calcium-phosphorus product was normal. The lesions slowly resolved upon discontinuation of nadroparin. We conclude that calcifying panniculitis is a rare complication associated with the subcutaneous administration of nadroparin-calcium that may rarely also occur in the absence of renal disturbances. Low molecular weight calcium-containing heparins should probably be used with caution in the presence of hyperparathyroidism.
Campanelli
A
A
Department of Dermatology, University Hospital of Geneva, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. alexandre.campanelli@hcuge.ch
Kaya
G
G
Masouyé
I
I
Borradori
L
L
D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D002115:Calciphylaxis / Q000097:blood / Q000209:etiology* / Q000473:pathology; D003863:Depression / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects; D008875:Middle Aged; D017762:Nadroparin / Q000009:adverse effects* / Q000627:therapeutic use; D010018:Osteomalacia / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D015434:Panniculitis / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D010264:Paraplegia / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D012867:Skin / Q000473:pathology
D000925:Anticoagulants; D017762:Nadroparin; D010281:Parathyroid Hormone