Calcifications on the Entire Legs of a Systemic Lupus Erythematosus Patient

Systemic lupus erythematosus (SLE) is a relatively common entity in rheumatology. Skin involvements such as nodules, vasculitis, and calcifications are commonly reported in patients with SLE [[1] [2]]. In our center, we encounter many rheumatoid patients referred from our rheumatology clinic. However, the case shown here was very unusual even to our experienced eyes.

A 37-year-old female patient, who had suffered from SLE for 16 years, had acquired progressive calcifications on the entirety of both of her legs. The calcification lesions were initially not severe and were limited to the lower leg area. However, the progression accelerated into groups of calcifications on both legs, which resulted in multiple leg defects ([Figs. 1], [2]). Her computed tomography (CT) angiography clearly showed the extent of the disease ([Fig. 3]). To help heal the wounds, immune suppressive drugs were administered, but the patient's condition was serious. Though administration of intravenous immunoglobulin was temporary effective to control the SLE, the wounds worsened, which led to sepsis. The wounds progressed despite our efforts. We serially debrided the infected defects and covered the defects with free flaps and 0.010-inch split-thickness skin grafts from the thighs ([Fig. 4]). Up to the present, a total of 18 surgical procedures have been performed. The wounds are now stable with conservative treatment.

Fig. 1 Multiple left leg defects. The left leg defects shown here are arose from calcinoses, which occurred in both legs.

Fig. 2 Multiple right leg defects. The right leg defects shown here are arose from calcinoses, which occurred in both legs.

Fig. 3 Computed tomography (CT) angiography of the legs. CT angiography clearly demonstrated the extent of the calcifications.

Fig. 4 Postoperative view of the left leg. The left leg is shown after coverage of the defect with a thoracodorsal perforator free flap.

Calcifications with this extent of progression in a SLE patient are extremely rare [[3]]. Nevertheless, this case reminds us that we should not overlook skin involvements associated with SLE, especially progressive calcifications, which can lead to serious morbidities.

No potential conflict of interest relevant to this article was reported.

• REFERENCES

• 1 Rothfield N, Sontheimer RD, Bernstein M. Lupus erythematosus: systemic and cutaneous manifestations. Clin Dermatol 2006; 24: 348-362
• 2 Gutierrez Jr A, Wetter DA. Calcinosis cutis in autoimmune connective tissue diseases. Dermatol Ther 2012; 25: 195-206
• 3 Tristano AG, Villarroel JL, Rodriguez MA. et al. Calcinosis cutis universalis in a patient with systemic lupus erythematosus. Clin Rheumatol 2006; 25: 70-74

Publication History

Received: 10 May 2016

Accepted: 23 August 2016

Article published online:
20 April 2022