Calcinosis Universalis: Cause for a Hard Airway

Calcinosis universalis is a rare subtype of connective tissue diseases known as calcinosis cutis. The disease is described as diffuse calcium salt deposits in subcutaneous, fibrous muscle structures, and tendons. Calcinosis cutis typically occurs secondary to a tissue damaging disease such as dermatomyositis, systemic lupus erythematosus, and Sjogren syndrome, presenting before age 20 and predominantly affecting women. Calcinosis universalis presents challenges for anesthesia providers as joint calcification can make positioning difficult, vascular access becomes increasingly difficult over time as iatrogenic calcifications limit access sites, and pharyngeal and epiglottic structures can be involved leading to obstruction of the airway. However, anesthesia management of these patients has rarely been reported in the literature. We present a patient with calcinosis universalis with reported difficult airway who was scheduled for endoscopic ultrasound guided biopsy necessitating general anesthesia.