Clinical Rheumatology

, Volume 25, Issue 1, pp 70–74 | Cite as

Calcinosis cutis universalis in a patient with systemic lupus erythematosus

  • Antonio G. Tristano
  • José L. Villarroel
  • María A. Rodríguez
  • Alberto Millan
Case Report


Deposition of calcium salts in the skin and subcutaneous tissue occurs in a variety of rheumatic diseases, being most commonly associated with scleroderma, CREST (calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia), dermatomyositis, and overlap syndromes but is a rare complication of systemic lupus erythematosus (SLE). Calcinosis is classified into four subsets: dystrophic, metastatic, idiopathic, or calciphylaxis/iatrogenic. The pathophysiology of calcinosis cutis remains unclear. Our patient developed extensive areas of calcifications in the trunk and extremities (calcinosis universalis) 8 years after SLE diagnosis, which would correspond to a form of dystrophic calcification. No response was observed after treatment with oral diltiazem for 3 months. We review the literature on the pathogenesis and prevalence of calcinosis universalis in SLE.


Calcinosis cutis Calcinosis universalis Leg ulcers Systemic lupus erythematosus 


  1. 1.
    Muller SA, Winkelmann RK, Brunsting LA (1959) Calcinosis in dermatomyositis. Arch Dermatol 79:669–673Google Scholar
  2. 2.
    Muller SA, Brunsting LA, Winkelmann RK (1959) Calcinosis cutis: its relationship to scleroderma. Arch Dermatol 80:15–21Google Scholar
  3. 3.
    Hashiro M, Maeda M, Kobayashi Y, Yoshikawa K (1989) A giant calcifying pseudocyst seen in a patient with overlap syndrome. J Dermatol 16:146–149PubMedGoogle Scholar
  4. 4.
    Keats TE (1961) The collagen diseases: a demonstration of the nonspecificity of their extrapulmonary manifestations. Am J Roentgenol Radium Ther Nucl Med 86:938–943PubMedGoogle Scholar
  5. 5.
    Kabir I, Lorincz LA (1965) Chronic disseminated lupus erythematosus and calcinosis cutis. Arch Dermatol 92:328–330CrossRefGoogle Scholar
  6. 6.
    Coltoiu AL, Mateescu D, Diaconu J (1968) SLE, calcifying polymyositis and ascitogenic cirrhosis. Rom Med Rev 12:29–32PubMedGoogle Scholar
  7. 7.
    Kabir DI, Malkinson FD (1969) Lupus erythematosus and calcinosis cutis. Arch Dermatol 100:17–22CrossRefPubMedGoogle Scholar
  8. 8.
    Tay CH (1970) Cutaneous manifestations of systemic lupus erythematosus: a clinical study from Singapore. Australas J Dermatol 11:30–41PubMedGoogle Scholar
  9. 9.
    Savin JA (1971) Systemic lupus erythematosus with ectopic calcification. Br J Dermatol 84:191–192PubMedGoogle Scholar
  10. 10.
    Powell RJ (1974) Systemic lupus erythematosus with widespread subcutaneous fat calcification. Proc R Soc Med 67:215–217PubMedGoogle Scholar
  11. 11.
    Quismoro FP, Dubois EL, Chandor SB (1975) Soft-tissue calcification in systemic lupus erythematosus. Arch Dermatol 111:352–356CrossRefPubMedGoogle Scholar
  12. 12.
    Budin JA, Feldman F (1975) Soft tissue calcifications in systemic lupus erythematosus. Am J Roentgenol Radium Ther Nucl Med 124:358–364PubMedGoogle Scholar
  13. 13.
    Taneda A, Masutani M, Ogawa H (1975) A case of systemic lupus erythematosus associated with large leg ulcers and calcification of the skin. Jpn J Clin Dermatol 29:777–781Google Scholar
  14. 14.
    Weinberger A, Kaplan JG, Myers AR (1979) Extensive soft tissue calcification (calcinosis universalis) in systemic lupus erythematosus. Ann Rheum Dis 38:384–386PubMedGoogle Scholar
  15. 15.
    Simons-Ling N, Schachner L, Penneys N, Gorman H, Zillereulo G, Strauss J (1983) Childhood systemic lupus erythematosus. Arch Dermatol 119:491–494CrossRefPubMedGoogle Scholar
  16. 16.
    Katono E, Kabashima T, Kono I, Yamane K, Sakurai T, Kashiwagi H (1983) Case of systemic lupus erythematosus with extensive soft tissue calcification. Nippon Naika Gakkai Zasshi 72:1063–1067PubMedGoogle Scholar
  17. 17.
    Carette S, Urowitz MB (1983) Systemic lupus erythematosus and diffuse soft tissue calcification. Int J Dermatol 22:416–418PubMedGoogle Scholar
  18. 18.
    Nomura M, Okada N, Okada M, Yoshikawa K (1990) Large subcutaneous calcification in systemic lupus erythematosus. Arch Dermatol 126:1057–1059CrossRefPubMedGoogle Scholar
  19. 19.
    Rothe MJ, Grant-Kels JM, Rothfield NI (1990) Extensive calcinosis cutis with systemic lupus erythematosus. Arch Dermatol 126:1060–1063CrossRefPubMedGoogle Scholar
  20. 20.
    Kumakiri M, Kokubu J, Tanaka H, Ohkawara A, Tokunaka H (1992) Pseudocysts around the interphalangeal joints as a manifestation of calcinosis cutis in a patient with lupus nephritis undergoing hemodialysis. Arch Dermatol 128:120–121CrossRefPubMedGoogle Scholar
  21. 21.
    Minami A, Suda K, Kaneda K, Kumakiri M (1994) Extensive subcutaneous calcification of the forearm in systemic lupus erythematosus. J Hand Surg [Br] 19:638–641Google Scholar
  22. 22.
    Cousins MAM, Jones DB, Whyte MP, Monafo WW (1997) Surgical management of calcinosis cutis universalis in systemic lupus erythematosus. Arthritis Rheum 40:570–572PubMedGoogle Scholar
  23. 23.
    Park YM, Lee SJ, Kang H, Cho SH (1999) Large subcutaneous calcification in systemic lupus erythematosus: treatment with oral aluminum hydroxide administration followed by surgical excision. J Korean Med Sci 14:589–592PubMedGoogle Scholar
  24. 24.
    Walsh JS, Fairley JA (1995) Calcifying disorders of skin. J Am Acad Dermatol 33:693–706CrossRefPubMedGoogle Scholar
  25. 25.
    Touart DM, Sau P (1998) Cutaneous deposition diseases. Part II. J Am Acad Dermatol 39:527–544PubMedGoogle Scholar
  26. 26.
    Paul H, Reginato AJ, Schumacher HR (1983) Alizarin red S staining as a screening test to detect calcium compounds in synovial fluid. Arthritis Rheum 26:191–200PubMedGoogle Scholar
  27. 27.
    Neuman WF, DiStefano V, Mubryan BJ (1951) The surface chemistry of bone. III. Observations on the role of phosphatase. J Biol Chem 193:227–236PubMedGoogle Scholar
  28. 28.
    Rabens SF, Bethune JE (1975) Disodium etidronate therapy for dystrophic cutaneous calcification. Arch Dermatol 111:357–361CrossRefPubMedGoogle Scholar
  29. 29.
    Berger RG, Featherstone GL, Raasch RH, McCartney WH, Hadler NM (1987) Treatment of calcinosis universalis with low-dose warfarin. Am J Med 83:72–76CrossRefGoogle Scholar
  30. 30.
    Yoshida S, Torikai K (1993) The effects of warfarin on calcinosis in a patient with systemic sclerosis. J Rheumatol 20:1233–1235PubMedGoogle Scholar
  31. 31.
    Palmieri GMA, Sebes JI, Aelion JA et al (1995) Treatment of calcinosis with diltiazem. Arthritis Rheum 38:1646–1654PubMedGoogle Scholar
  32. 32.
    Dolan AL, Kassimos D, Gibson T, Kingsley GH (1995) Diltiazem induces remission of calcinosis in scleroderma. Br J Rheumatol 34:576–578PubMedGoogle Scholar
  33. 33.
    Lee SS, Felsenstein J, Tanzer FR (1978) Calcinosis cutis circumscripta: treatment with an intralesional corticosteroid. Arch Dermatol 114:1080–1081CrossRefPubMedGoogle Scholar
  34. 34.
    Wang WJ, Lo WL, Wong CK (1988) Calcinosis cutis in juvenile dermatomyositis: remarkable response to aluminum hydroxide therapy. Arch Dermatol 124:1721–1722CrossRefPubMedGoogle Scholar
  35. 35.
    Lipskeir E, Weizenbluth M (1989) Calcinosis circumscripta: indications for surgery. Bull Hosp Jt Dis Orthop 49:75–84Google Scholar

Copyright information

© Clinical Rheumatology 2005

Authors and Affiliations

  • Antonio G. Tristano
    • 1
    • 5
  • José L. Villarroel
    • 2
  • María A. Rodríguez
    • 3
  • Alberto Millan
    • 2
    • 4
  1. 1.Servicio de Medicina InternaHospital Dr. Domingo LucianiCaracasVenezuela
  2. 2.Servicio de ReumatologíaHospital Universitario de CaracasCaracasVenezuela
  3. 3.Servicio de DermatologíaHospital Universitario de CaracasCaracasVenezuela
  4. 4.Servicio de Medicina InternaHospital Universitario de CaracasCaracasVenezuela
  5. 5.MiamiUSA

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