Surgical Management of Ulcerative Calcinosis Cutis in the Lower Extremity

The purpose of this case study is to investigate the surgical treatment of a unique presentation of ulcerative cutaneous calcinosis or calcinosis cutis of the lower extremity. In this case, a 77-year-old Latin-American female who reported no significant past medical history presented to Aventura Hospital and Medical Center Emergency Department from her home accompanied by her daughter complaining of worsening right lower extremity erythema, edema, increased temperature and pain. Upon physical examination, it was noted the patient presented with multiple cutaneous calcified nodules to bilateral lower extremities, which she stated have been present for approximately forty years. At the time of evaluation, one of the nodules on the lateral aspect of the right lower extremity ulcerated and became infected due to unknown etiology which lead to cellulitis of this limb. X-ray imaging studies of bilateral lower extremities described extensive sheet-like soft tissue calcification overlying the mid to distal lower extremities. Serology reports of this patient was revealed positive for rheumatoid factor, ANA, SS-A/Ro antibody, and SS-B/La antibody. Due to the evidence of frank purulence and cellulitic changes to the infected nodule, the patient was taken to surgery the following day for sharp debridement and biopsy of the site. Post-operatively, there were minimal signs of improved healing to the wound base although there was evidence of decreased erythema and edema to the extremity following the initial debridement and biopsy. Four days following the initial surgical invention, the patient was taken for a second operative procedure, which included a wide excisional biopsy with application of acellular dermal matrix and negative pressure therapy. It was during this secondary debridement that further calcified deposits were encountered and submitted to pathology. Pathology diagnosed the specimen submitted as cutaneous calcinosis. After undergoing routine bi-weekly wound care, the patient healed unremarkably.