Calcification at the Level of 12th Dorsal and 1st Lumbar Vertebrae

A 46-year-old man presented with pain in his left lower limb for the past 2 months. He was taking herbal medications for diabetes, which he had for the past 3 years. He had a history of alcohol dependence for the last 12 years, but recently he was able to overcome his addiction with the help of counseling. He had no history of recurrent abdominal pain and had no complaints of steatorrhea. Clinical examination revealed his body mass index (BMI) was 18 kg/m², pulse 110 beats per minute, blood pressure 124/78 mm Hg, and absence of icterus. The blood tests showed hemoglobin 11.5 gm/dL, blood sugar (fasting) 440 mg/dL (reference range 60-110), and glycated hemoglobin (HbA1c) 9.5% (good control <6.5), serum calcium 8.9 mg/dL (reference value 8.5-10.5) and vitamin D₃ 16 ng/mL (reference range 20-50), serum creatinine 1.2 mg/dL (reference value 0.7-1.4), alanine transaminase 35 U/L (reference range 5-45). For pain in the lower limb, a radiograph of the lumbosacral vertebral spine (Fig. 1) was taken; however, numerous dense calcifications were noted across the 12th dorsal and 1st lumbar vertebrae, more so on the right side. Unenhanced abdominal computed tomography (CT) scans (Figs 2A and B) were obtained. The patient received an oral dosage of 500 mg of metformin twice a day, along with 10 units of human regular insulin delivered via subcutaneous injection in the morning and 8 units in the evening. His glucose levels were monitored at regular intervals. In a week's time, the patient's fasting blood glucose level decreased to 110 mg/dL. He was also prescribed calcium supplementation alongside weekly oral administration of vitamin D₃ (60,000 IU). Additionally, oral pregabalin at a dosage of 75 mg was administered twice a day.