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PICTORIAL QUIZ
Year : 2021  |  Volume : 38  |  Issue : 1  |  Page : 84-85  

An elderly female with dyspnea and skin lesion


1 Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication31-Dec-2020

Correspondence Address:
Saurabh Mittal
Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_534_19

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   Abstract 



How to cite this article:
Boppana TK, Mittal S, Madan K, Mohan A. An elderly female with dyspnea and skin lesion. Lung India 2021;38:84-5

How to cite this URL:
Boppana TK, Mittal S, Madan K, Mohan A. An elderly female with dyspnea and skin lesion. Lung India [serial online] 2021 [cited 2021 Jan 19];38:84-5. Available from: https://www.lungindia.com/text.asp?2021/38/1/84/306023



A 60-year-old lady presented to the outpatient services with dry cough and shortness of breath for the past 3 years. Shortness of breath had gradually progressed over these years, and now, she had dyspnea during her day-to-day activities. She also had a history of dysphagia to solids as well as liquids for the same duration. She had a history of Raynaud's phenomenon for many years but had never taken any treatment for the same. She had no history of skin thickening or muscle weakness. She was a lifelong nonsmoker and had no significant past history. On examination, she had pallor, and her vital parameters were stable. She had white chalky lesions on fingertips [Figure 1]. Chest examination demonstrated bilateral basal crepts. On cardiovascular examination, she had a loud second heart sound.
Figure 1: The white skin lesion on the index finger

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   Question Top


What is this skin lesion known as, and what is the likely diagnosis?


   Answer Top


Calcinosis cutis associated with CREST syndrome.


   Discussion Top


Calcinosis cutis is characterized by the deposition of calcium salts in the skin and subcutaneous tissue. It is a form of dystrophic calcification where denatured proteins from necrotic tissue get calcified, and serum calcium and phosphate levels are normal. This type of calcification can occur commonly in connective tissue disorders, especially scleroderma, systemic lupus erythematosus, and dermatomyositis.[1] This patient's presentation is consistent with the diagnosis of CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia). On further evaluation, she was found to have pulmonary hypertension on echocardiography and positive anticentromere antibodies. Calcinosis may be seen in 25%–40% of patients with a limited form of systemic sclerosis, typically after more than 10 years of disease onset. Usually, this form of nodular calcification occurs at the sites of repeated microtrauma. The commonly involved areas are the forearms, elbow, volar aspects of fingertips, metacarpophalangeal, and interphalangeal joints.[2] Treatment for calcinosis cutis is usually challenging. Efforts should be made to increase the blood flow to the extremities, which include trauma avoidance, smoking cessation, and avoiding cold exposure. Diltiazem and minocycline have been used with variable success rates. For smaller lesions, surgery is the best treatment method. Carbon dioxide laser may be used for the lesion removal.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Reiter N, El-Shabrawi L, Leinweber B, Berghold A, Aberer E. Calcinosis cutis: Part I. Diagnostic pathway. J Am Acad Dermatol 2011;65:1-12.  Back to cited text no. 1
    
2.
Valenzuela A, Chung L. Calcinosis: Pathophysiology and management. Curr Opin Rheumatol 2015;27:542-8.  Back to cited text no. 2
    


    Figures

  [Figure 1]



 

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