Progressive Elbow Contracture and Skin Thickening Due to Dystrophic Calcification
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.