Calcinosis cutis confined to the dermis after intravenous administration of a calcium preparation: a case report and review of the Japanese literature.
A 61-year-old female received intravenous injection of calcium chloride after common iliac artery bypass surgery. A red flare appeared at the site of the intravenous infusion on the left forearm and gradually progressed to induration. Seven weeks later, she was referred to the Department of Dermatology for management. Physical examination showed an indurated plaque measuring 13 × 65 mm in size, with linearly distributed ulcers covered by yellowish-white substance, surrounded by reddish skin. Laboratory tests showed no significant abnormalities including serum calcium, phosphate and thyroid hormones. Cultures were negative for microorganisms. Histopathological examination showed calcium deposition confined to the dermis. The lesion healed spontaneously within 2 months with scar formation. A review of the Japanese literature showed confinement of calcium deposits to the dermis in most of the reported cases. We speculate that the pathomechanism of dermal calcinosis includes needle-induced tissue injury with capillary destruction, leading to release of excess calcium between collagen fibers, and its binding to phosphate in the dermis and deposition as calcium phosphate crystals.
Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Soko
S
Watanabe
Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Takeaki
T
Shioda
Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Ken
K
Kobayashi
Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Sumiko
S
Ishizaki
Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Fumio
F
Ito
Department of Pathology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Mariko
M
Fujibayashi
Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Masaru
M
Tanaka
Calcium chloride; Iatrogenic calcinosis