Subcutaneous calcinosis revealed by an elbow trauma

A 46-year-old woman presented to the trauma department with a 15-day history of closed trauma of the right elbow following a domestic accident (she fell whilst tidying up the house), causing her pain and impaired physical function. On physical examination, she had multiple painful subcutaneous nodules over the right elbow. No other traumatic injuries were present. A radiograph of the elbow showed no fracture, but calcifications overlying the extensor surfaces of the articulation and the forearm, related to a subcutaneous calcinosis. A detailed interrogation revealed a history of Raynaud´s phenomenon and clinical signs of gastroesophageal reflux were remarkable. Subcutaneous calcinosis results from the deposition of calcium hydroxyapatite crystals and other calcium salts. It can be seen as a cutaneous and subcutaneous manifestation of dermatomyositis, lupus erythematosus, systemic sclerosis, and other connective-tissue disorders. It appears electively in tissues that are under chronic stress such as the hands and the extension surface of the forearms and elbows, with a risk of transformation into an infected ulceration that can significantly affect quality of life. Our patient was referred to the rheumatology department, where she received, after clinical and paraclinical investigations, a diagnosis of scleroderma. A treatment was initiated, including bisphosphates and immunosuppressants.