Metastatic Calcinosis Cutis: Unusual Locations in End-Stage Renal Disease

Metastatic calcinosis cutis is a rare consequence of end-stage renal disease (ESRD), which occurs due to elevated levels of serum phosphorus and abnormal phosphate and calcium metabolism, leading to the precipitation and deposition of calcium in the cutaneous and subcutaneous tissues. This paper reports the case of a 33-year-old male with ESRD and a six-year history of hemodialysis treatment who presented with multiple areas of gradually enlarging, lobulated calcified soft tissue masses observed bilaterally at the level of the acromioclavicular joint and superomedial aspect of the right thigh, extensively involving the perineal region and the right superior anterior chest wall. The unique character of this case is the rare involvement of the sternoclavicular joint and the symphysis pubis. The relevant laboratory findings included elevated levels of serum phosphorus, blood urea nitrogen, and creatinine, which were consistent with metastatic calcinosis cutis as a consequence of ESRD. The treatment of secondary calcinosis cutis primarily includes low-calcium and low-phosphorus diets, dialysates, and phosphate binders, except aluminum-containing binders, which were advised for this patient. Imaging is the mainstay for the diagnosis of calcinosis cutis, and as metastatic calcinosis cutis is an infrequent and debilitating consequence of ESRD, prompt diagnosis and appropriate treatment are paramount.