The patient was an 83-year-old woman who complained of rapidly progressive cellulitis in both lower limbs. On physical examination edema of both legs stony of a hard consistency, erythema and ulcers with white exudation areas was seen, along with facial and neckline telangiectasias, sclerodactyly and facial skin sclerosis.

With a suspected diagnosis of limited systemic sclerosis with secondary calcinosis, X-rays of the lower limbs were performed, which showed deposition of calcium in the subcutaneous tissue (Fig. 1). Blood tests showed positive antinuclear antibodies 1/1280 with anticentromere positivity. The patient also had mild-moderate stable renal insufficiency (creatinine 1.23mg/dl), with a 24h urinalysis that showed a creatinine clearance of 46ml/min and ruled out the existence of proteinuria. The patient complained of pyrosis and dysphagia; given her general condition, and in the absence of an alternative diagnosis, it was assumed that the digestive and renal affectations were secondary to the underlying condition. The patient received parenteral treatment with amoxicillin/clavulanic acid, with improvement of ulcers and disappearance of erythema and the local discharge.

Fig. 1.

Plain X-ray of the left lower extremity, showing calcifications in the subcutaneous tissue.

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Calcinosis cutis in its dystrophic variant is a common manifestation of autoimmune diseases such as systemic sclerosis,1 especially in its limited form, which is belatedly present in up to 25% of cases.2 Anti-centromere antibodies are characteristic of this variety of sclerosis, being more frequent in elderly patients.3

Subcutaneous deposits of calcium hydroxyapatite are responsible for decreasing the thickness and resistance of the skin, with frequent4 ulcers. Bacterial superinfection is a relatively common phenomenon that affects the local prognosis5 and which always has to be a differential diagnosis in case of an unfavorable progression.

The authors declare no conflicts of interest.