Dystrophic calcinosis cutis in chronic venous disease of the lower limbs

Lower limb ulcers secondary to chronic venous disease (CVD) are a significant public health problem in Brazil and account for about 70% of these ulcers. Despite recent technological advances and the various therapeutic options for treatment of these chronic injuries, several factors may be involved in resistance to treatment. Dystrophic calcinosis cutis (DCC) is a rare and often underdiagnosed condition that, when in conjunction with CVD, may be associated with a refractory healing process. In this article, we report a case of DCC in a patient with CVD and discuss its etiology, pathophysiology and possible treatment options.

Keywords:
venous insufficiency; skin ulcer; leg ulcer; varicose ulcer; calcinosis; wound healing

Authorship

Carolina Heil Arostegui Pacheco

Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Rio de Janeiro, RJ, Brasil.Universidade do Estado do Rio de JaneiroBrasilRio de Janeiro, RJ, BrasilUniversidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0001-9077-0647

Carmen Lucia Lascasas Porto

Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil.Universidade do Estado do Rio de JaneiroBrasilRio de Janeiro, RJ, BrasilUniversidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0003-2531-4308

Juliana de Miranda Vieira

http://orcid.org/0000-0001-6027-2073

Ana Leticia de Mattos Milhomens

http://orcid.org/0000-0003-0436-0567

Rossano Kepler Alvim Fiorelli

Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Hospital Universitário Gaffrée e Guinle, Rio de Janeiro, RJ, Brasil.Universidade Federal do Estado do Rio de JaneiroBrasilRio de Janeiro, RJ, BrasilUniversidade Federal do Estado do Rio de Janeiro – UNIRIO, Hospital Universitário Gaffrée e Guinle, Rio de Janeiro, RJ, Brasil.

Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Rio de Janeiro, RJ, Brasil.Universidade Federal do Estado do Rio de JaneiroBrasilRio de Janeiro, RJ, BrasilUniversidade Federal do Estado do Rio de Janeiro – UNIRIO, Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0001-5236-0903

Stenio Karlos Alvim Fiorell

http://orcid.org/0000-0003-4258-2988

Marcos Arêas Marques

http://orcid.org/0000-0002-5329-7819

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Correspondence Marcos Arêas Marques Rua Assunção, 217/704 - Botafogo CEP 22251-030 - Rio de Janeiro (RJ), Brasil Tel.: +55 (21) 99859-0160 E-mail: mareasmarques@gmail.com

Author information

CHAP - Ecografia Vascular resident, Hospital Universitário Pedro Ernesto (HUPE), Universidade do Estado do Rio de Janeiro (UERJ).

CLLP - Associate professor, Faculdade de Ciências Médicas; Chief of Serviço de Angiologia, Hospital Universitário Pedro Ernesto (HUPE), Universidade do Estado do Rio de Janeiro (UERJ).

JMV - PhD candidate from Programa de Fisiopatologia Clínica e Experimental, Universidade do Estado do Rio de Janeiro (UERJ).

ALMM and MAM – Physician, Unidade Docente Assistencial de Angiologia, Hospital Universitário Pedro Ernesto (HUPE), Universidade do Estado do Rio de Janeiro (UERJ).

MAM - Serviço de Cirurgia Vascular, Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro (UNIRIO).

RKAF - Full professor and chief of Departamento de Cirurgia Geral e Especializada, Programa de Pós-graduação em Medicina coordinator at Universidade Federal do Estado do Rio de Janeiro (UNIRIO).

SKAF - Adjunct professor, head of Disciplina de Angiologia e Cirurgia Vascular, Universidade Federal do Estado do Rio de Janeiro (UNIRIO).

Author contributions

Conception and design: CHAP, MAM

Analysis and interpretation: CHAP, CLLP, ALMM, JMV, SKAF, RKAF, MAM

Data collection: CHAP

Writing the article: CHAP, MAM

Critical revision of the article: CHAP, CLLP, ALMM, JMV, SKAF, RKAF, MAM

Final approval of the article*: CHAP, CLLP, ALMM, JMV, MAM

Statistical analysis: CHAP, MAM

Overall responsibility: MAM

*All authors have read and approved of the final version of the article submitted to J Vasc Bras.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (5)

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Figure 1
Multiple ulcers on the mid-distal third of the left leg, with diameters varying from 1.0 to 2.5 cm, with moderate exudate and presence of spontaneous extrusion of fragmented, stony, white material, but free from signs of secondary infection. Dressed with calcium alginate and sodium.

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Figure 2
Simple X-rays of the lower limbs: lesions compatible with amorphous calcifications of soft tissues of the external aspect of the mid and lower third of the legs.

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Figure 3
(A) and (B) Color Doppler ultrasound of the lower limbs (B-mode) with hyperechogenic images that generate intense acoustic shadows, with areas of convergence, suggestive of calcium deposits in the subcutaneous cellular tissues, in the mid-distal third of the leg in the region of the ulcers.

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Figure 4
A) Computed tomography of the lower limbs (transverse and longitudinal slices) showing diffuse calcium deposits distributed concentrically around the mid and distal thirds of both lower limbs, with no deposits present in other regions of the body.

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Figure 5
Mechanical extraction of calcifed material.

Figure 1 Multiple ulcers on the mid-distal third of the left leg, with diameters varying from 1.0 to 2.5 cm, with moderate exudate and presence of spontaneous extrusion of fragmented, stony, white material, but free from signs of secondary infection. Dressed with calcium alginate and sodium.

Figure 2 Simple X-rays of the lower limbs: lesions compatible with amorphous calcifications of soft tissues of the external aspect of the mid and lower third of the legs.

Figure 3 (A) and (B) Color Doppler ultrasound of the lower limbs (B-mode) with hyperechogenic images that generate intense acoustic shadows, with areas of convergence, suggestive of calcium deposits in the subcutaneous cellular tissues, in the mid-distal third of the leg in the region of the ulcers.

Figure 4 A) Computed tomography of the lower limbs (transverse and longitudinal slices) showing diffuse calcium deposits distributed concentrically around the mid and distal thirds of both lower limbs, with no deposits present in other regions of the body.

Figure 5 Mechanical extraction of calcifed material.

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Dystrophic calcinosis cutis in chronic venous disease of the lower limbs

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[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.