I think it's calcinosis of fingers ; it can be a part of CREST syndrome
or other collagenopathies.
You should find the other signs, if present (often they are not all present).
You should do capillaroscopy, LE phenomenon (it's so in English language too?),
auto-antibodies, etc.
Best regards,
Reverberi Sandro
Divisione di Ortopedia e Traumatologia
Azienda Ospedaliera ASMN
Reggio Emilia
reverberi.sandro@asmn.re.it
Your case is most likely to be Tumoral calcinosis.
I saw the same picture in a patient on hemodialysis for Chronic Renal Failure.
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Freih Odeh Abu Hassan,
M.D.Orth. , F.R.C.S.(Eng) , F.R.C.S.(Tr.&Orth.),
Asst.Prof. of Orthopedics and Pediatrics Orthopedics Surgery,
University of Jordan - Amman.
Finger tip Calcinosis could be manifested intracutaneous or
subcutaneous among other components of Scleroderma. The finger tip is
tender and makes impossible to pick up objects; Sometimes the skin breaks and the deposits
extrude as shown in your photos. You could find it in 15% of patients with diffuse type of
scleroderma and in 45% in the limited cutaneous variety.
Surgical evacuation of the deposits is recommended while leaving the compromised skin for
secondary healing rather than using mutilating needles and sutures. Recurrence is not
infrequent
S. Luboshitz
Editor's Comments
I have no personal experience with this condition but base these comments on the
bibliography which was assembled for this case. It would appear that a large number of
cases of digital calcification are related to chronic renal failure and
hyperparathyroidism; so it would be prudent to rule this out. It may already have been
done as Dr Tetik stated that the patient's biochemistry was normal. The possible
association with scleroderma or with the CREST syndrome (Calcinosis, Raynaulds,
Esophagitis, Sclerodactyly, Telangectasis) should also be examined but the literature
suggests that there are a number of idiopathic cases in which the only abnormality is the
calcinosis.
Note that these comments are based on the diagnosis of the condition as "tumorous
calcinosis". Are there any other suggestions? The Xray papers suggested that one
could see "chicken wire" pattern of radiolucencies in the calcific area
corresponding to fibrous septae that are found in the specimen. I thought this pattern was
present in the Xray. The other pathognomonic Xray sign mentioned was fluid levels in the
deposits. I assume these are only seen in larger deposits.
Myles Clough
Orthopaedic Surgeon, Kamloops, BC
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