Ureteral calcinosis in juvenile dermatomyositis: successful precocious surgical management

Area of Science:

• Pediatric Rheumatology
• Urology
• Medical Case Reports

Background:

• Juvenile dermatomyositis (JDM) is a rare autoimmune disease causing vasculitis affecting skin and muscles.
• Urinary tract complications, including ureteral strictures and calcinosis, are rare but serious manifestations of JDM.
• This report presents the fourth documented case of ureteral calcinosis secondary to JDM.

Observation:

• A 9-year-old girl with severe JDM experienced recurrent urinary tract infections.
• Imaging revealed bilateral ureteral dilation and calculus; ureteroscopy confirmed bilateral ureteral calcinosis.
• Initial endourological management with double-J stents provided only transient improvement.

Findings:

• Surgical resection of the affected ureteral segments was the definitive treatment for bilateral ureteral strictures and calcinosis.
• Histopathological analysis confirmed ureteral calcinosis.
• Combined immunosuppressive therapy and surgical intervention successfully controlled the urinary complications.

Implications:

• Endourological evaluation is crucial for diagnosing urinary tract involvement in JDM, as standard radiological methods can be misleading.
• This case underscores the importance of a multidisciplinary approach involving rheumatology and urology for managing complex JDM complications.
• Successful surgical management offers a potential treatment pathway for similar rare cases of JDM-associated ureteral pathology.