title: An unusual adverse effect of nadroparin injections: Calcinosis cutis.
abstract: In 1988, Tumiati et al described the first case of calcinosis cutis related to a calcium-containing heparin. Since then, only 18 cases have been reported in the literature; they usually have an altered calcium-phosphate product, an elevated parathyroid hormone (PTH), or both. We report a 33-year-old patient who developed calcinosis cutis at sites of nadroparin injections without any disturbance of calcium-phosphate product, PTH, or vitamin D. The pathogenesis of calcinosis cutis secondary to nadroparin injections remains controversial; Proposed causes included metastatic, dystrophic, iatrogenic, or multifactorial etiologies. This is the first case of multiple nodules of calcinosis cutis without alterations of calcium-phosphate product, PTH, or vitamin D, which supports an iatrogenic mechanism. We also suggest that calcinosis cutis could be more frequent than we thought and is probably an underdiagnosed entity.
authors.affiliation: Hospital Universitario Fundacion Alcorcon, Alcorcon, Madrid, Spain.
authors.forename: Almudena
authors.initials: A
authors.lastname: Nuno-Gonzalez
authors.forename: Leticia
authors.initials: L
authors.lastname: Calzado-Villarreal
authors.forename: Marta
authors.initials: M
authors.lastname: Gutierrez-Pascual
authors.forename: Reyes
authors.initials: R
authors.lastname: Gamo-Villegas
authors.forename: Henar
authors.initials: H
authors.lastname: Sanz-Robles
authors.forename: Araceli
authors.initials: A
authors.lastname: Sanchez-Gilo
authors.forename: Fernando
authors.initials: F
authors.lastname: Pinedo-Moraleda
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Lopez-Estebaranz
mesh_terms: D000328:Adult; D000638:Amiodarone / Q000627:therapeutic use; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy; D001706:Biopsy; D002114:Calcinosis / Q000139:chemically induced* / Q000473:pathology; D002118:Calcium / Q000032:analysis; D017984:Enoxaparin / Q000627:therapeutic use; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D017762:Nadroparin / Q000008:administration & dosage / Q000009:adverse effects*; D012871:Skin Diseases / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D017762:Nadroparin; D000638:Amiodarone; D002118:Calcium