Oral lesion in a patient with calcinosis and arthritis: case report and differential diagnosis

Calcinosis, the process whereby calcium salts are deposited in soft tissues, may be idiopathic, metastatic or dystrophic. Metastatic calcinosis develops in a variety of systemic diseases characterized by either hypercalcemia, hyperphosphatemia, or both. Dystrophic calcinosis refers to calcification of previously damaged or necrotic tissue. It may be found accompanying inflammatory or degenerative conditions and is frequently associated with connective tissue diseases. When pathologic calcification is widespread, an attempt must be made to determine the underlying cause. A case is presented in which there was multifocal calcium deposition in soft tissues, including an intra-oral site. The patient also exhibited severe arthritis, sicca syndrome, focal alopecia and vitiligo. In view of this clinical spectrum, one of the "collagen diseases" (dermatomyositis, lupus erythematosus, rheumatoid arthritis, and scleroderma) was suspected as a predisposing factor for disseminated calcinosis. When diagnostic workup failed to reveal a specific connective tissue disease, it was concluded that "undifferentiated connective tissue disease" was responsible for dystrophic calcinosis.