An unusual case of steroid responsive idiopathic ectopic calcification

This case explores an unusual calcified lesion of the hand and its dramatic response to steroids. A 30-year-old lady presented to rheumatology with a 1-year history of swelling on the radial side of her right middle metacarpophalangeal joint. Over a 2-week period, she had developed swelling throughout her right hand. She was treated with intramuscular methylprednisolone injection and a weaning course of prednisolone. A series of photos and X-rays demonstrates the resolution of swelling and calcification after steroid treatment. This case reports a chronic calcified mass associated with an acute inflammatory episode in the hand. This is likely to represent rupture of a calcific deposit with the release of crystals into the soft tissue. While there is prior literature on treatment with bisphosphonates or surgery, a fast and complete response to modest dose steroids suggests that this would be the first treatment to try in such a case.