Calcinosis cutis in a patient with systemic lupus erythematosus: Case-based review

Background

Dystrophic calcinosis cutis (CC) is rarely observed in systemic lupus erythematosus (SLE).

Aim of the work

To present a case of SLE with a rare cutaneous complication of generalised form of dystrophic CC, most prominent in right infragluteal region, which led to abscess formation.

Case presentation

A 36-years old female with SLE was admitted to the Institute of rheumatology in Belgrade due to worsening of her condition and post-coronavirus disease 2019 (COVID-19) neck vein thrombosis. She was febrile (up to 38.5 °C) and had fatigue, extensive erythema, livedo reticularis and palpable “orange-peel” skin indurations extending symmetrically to infragluteal, suprapatellar, suprapubic and calf regions. Right infragluteal region had skin inflammation signs with fluctuating central lesion. Her laboratory findings were significant for markedly elevated acute phase reactants. Skin ultrasound showed signs of panniculitis with hypodermal hyperechogenicity and posterior acoustic attenuation. Radiography findings were significant for extensive calcifications in the buttock and knee soft tissue areas and it was confirmed on histopathology of the biopsy. She was started with triple antibiotics (cephtriaxone, ciprofloxacin and metronidazole), high corticosteroids, low molecular weight heparin (LMWH) and the abscess was incised. After resolution of skin infection her immunosuppressive therapy was modified considering her SLE condition, vein thrombosis and calcinosis cutis.

Conclusion

Calcinosis cutis is a serious skin complication of SLE as it could predispose to infection. Various pharmacological therapeutic approaches are applied with modest success.