Progressive Elbow Contracture and Skin Thickening Due to Dystrophic Calcification

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A 39-year-old woman was referred to Thammasat University Hospital because of a 6-month history of progressive skin thickening on both upper extremities and debilitating stiffness of both elbows, resembling systemic sclerosis. She reported no history of Raynaud phenomenon or puffy hands. Five years prior, she was diagnosed as having dermatomyositis (DM), based on the history of proximal muscle weakness, facial erythema, elevated serum creatinine phosphokinase level, and typical DM histological features from a muscle biopsy. At the time of referral, she had been in remission for 4 years and was taking 5 mg of prednisolone daily.
The physical examination revealed hyperpigmented, atrophic, and indurated skin extending from the shoulders to dorsum of both hands (Fig. 1). She could move her elbows only within a 60-degree arc (30- to 90-degree flexion-extension). No signs of active DM were observed: normal muscle strength and no cutaneous signs. Radiographic study of the patient’s arms demonstrated diffuse calcification of the skin (Fig. 2). A skin biopsy revealed subcutaneous fat necrosis and extensive calcification (Fig. 3). An improvement of elbow range of motion was documented after treatment with colchicine and calcium-channel blocker.
Joint contracture due to dystrophic calcification of the skin is an uncommon complication of juvenile DM and is rarely reported in adults.1,2 As in our case, such calcification may occur years after the diagnosis of DM without active myositis or DM rash, leading to potential misdiagnosis of systemic sclerosis.

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