ONLINE Images in the Medical Sciences| Volume 356, ISSUE 4, e35, October 2018

Extensive Calcinosis Cutis inOverlap Syndrome

      A 47-year-old Caucasian man presented to the rheumatology clinic to re-establish care after he had been lost to follow-up. He had been previously diagnosed with polymyositis (PM) and diffuse systemic sclerosis (SS) overlap syndrome. Clinical examination revealed extensive hard subcutaneous nodules on the patient's hands, elbows, shoulders, knees, hips, buttocks and back. Plain radiography of the hips showed extensive calcinosis cutis (Figures 1 and 2). Blood tests revealed elevated muscle enzymes and positivity for antinuclear antibody 1:2560 nucleolar pattern and anti-PM-Scl antibodies. Tests for anti-Scleroderma-70 and anti-RNA polymerase III antibodies were negative. Antinuclear matrix protein 2 autoantibodies, which are well described in PM and linked with calcinosis, were negative as well. The patient was started on prednisone and mycophenolate mofetil, which helped normalize the muscle enzymes but did not impact the calcinosis cutis.
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