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Pitfalls in interpretation: calcium that's not bone.
1University of California, San Diego, La Jolla, CA , USA. dlschneider@ucsd.edu
Summary
This case study details a 65-year-old woman with dermatomyositis and extensive calcinosis, presenting with widespread subcutaneous nodules. Her condition involved fluctuating creatine phosphokinase (CPK) levels, indicating disease activity despite current immunosuppressive therapy.
Area of Science:
- Rheumatology
- Dermatology
- Immunology
Background:
- Dermatomyositis is a rare idiopathic inflammatory myopathy.
- Extensive calcinosis is a known complication of dermatomyositis, impacting quality of life.
- Subcutaneous calcifications present a significant clinical challenge in managing dermatomyositis.
Purpose of the Study:
- To present a clinical case of a patient with dermatomyositis and extensive calcinosis.
- To highlight the physical examination findings and laboratory values in a patient with active dermatomyositis.
- To document the current medication regimen for managing dermatomyositis and its complications.
Main Methods:
- Case report of a 65-year-old female patient.
- Physical examination focused on subcutaneous nodules and distribution.
- Review of current laboratory values, including creatine phosphokinase (CPK).
- Documentation of current pharmacological treatment.
Main Results:
- The patient presented with widely distributed subcutaneous nodules on the chest and extremities.
- Current CPK level was 163 IU/L (normal range 0-175 IU/L).
- CPK levels peaked at 411 IU/L during a recent symptom flare.
- Current medications include Imuran, Prednisone, and conjugated equine estrogen.
Conclusions:
- Dermatomyositis with extensive calcinosis requires ongoing management and monitoring.
- Fluctuating CPK levels can indicate disease activity and the need for treatment adjustment.
- Comprehensive assessment including physical examination and laboratory markers is crucial for managing complex cases.