To the Editor: The medical mystery in the September 25 issue1involved a 48-year-old woman who had a 30-year history of dermatomyositistreated with prednisolone and who was admitted for depressionand nausea. An abdominal radiograph was obtained. The diagnosisis calcinosis universalis, shown here by the ectopic calcification(Figure 1B). This is a rare complication of dermatomyositisresulting from dystrophic calcification within the affectedtissue. There was also skin pressure necrosis, as seen in Figure 1A.
Figure 1. A 48-Year-Old Woman with Calcinosis Universalis.
Panel A shows multiple skin nodules and skin pressure necrosis of the right flank, and Panel B ectopic calcification.
Nicholas Magee, M.R.C.P. Rory Convery, M.R.C.P. Craigavon Area Hospital Portadown BT63 5QQ, Northern Ireland
Editor's note: We received 683 responses to this medical mystery,48 percent from physicians in practice, 29 percent from physiciansin training, and 10 percent from medical students. Sixty-sixpercent of the respondents gave explanations that were consistentwith dystrophic calcifications. Other explanations includedcancer (9 percent) (e.g., lymphoma; sarcoma; and pancreatic,gastric, colon, and ovarian carcinoma) and infection (6 percent)(e.g., tuberculosis, onchocerciasis, cysticercosis, trichinosis,and syphilis). We received answers from 67 countries, includingArmenia, Brazil, China, Cuba, Iran, Israel, Oman, Syria, Taiwan,Thailand, and Russia. It is impressive to see that the "artof medicine" transcends boundaries. We encourage all to respondto future medical mysteries.
References
Magee N, Convery R. A medical mystery. N Engl J Med 2003;349:1246-1246. [Free Full Text]
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