Refractory calcinosis in a patient with dermatomyositis: response to intravenous immune globulin

Abstract

Dermatomyositis is an inflammatory myopathy and commonly presents with progressive, symmetric proximal muscle weakness and cutaneous findings. Calcinosis is a severe manifestation that can be debilitating. The cutaneous manifestations of dermatomyositis may also develop in the absence of detectable muscle disease, and can persist after the successful treatment of myositis. The author reports a 30-year-old woman with biopsy-proven dermatomyositis who had failed previous trials of azathioprine and methotrexate. Her muscle weakness was controlled with mycophenolate mofetil and prednisone; however, she had recurrent attacks of painful calcinosis. The patient responded to intravenous immune globulin (IVIG) along with intravenous methylprednisone, followed by IVIG for 2 consecutive days each month. This regimen has been effective in preventing recurrence of her calcinosis. This case illustrates the cutaneous manifestation of dermatomyositis, which is often more refractory to treat as compared to the muscle involvement and require additional approaches such as IVIG.

Worsening of calcinosis cutis with teriparatide treatment in two osteoporotic patients

“…There is no specific treatment for the management of calcinosis cutis. Several case reports have highlighted the benefits of aluminium hydroxide, alendronate, intravenous immunoglobulin or electric shock wave lithotripsy . Teriparatide [rhPTH(1–34)], which is approved for the treatment of osteoporosis, is a recombinant form of PTH that stimulates osteoblast activity and inhibits osteoblast apoptosis.…”

“…Several case reports have highlighted the benefits of aluminium hydroxide, alendronate, intravenous immunoglobulin or electric shock wave lithotripsy. [10][11][12][13][14] Teriparatide [rhPTH(1-34)], which is approved for the treatment of osteoporosis, is a recombinant form of PTH that stimulates osteoblast activity and inhibits osteoblast apoptosis. In the medical literature, only three cases of calciphylaxis in patients receiving treatment with teriparatide have been reported.…”

The Value of Intravenous Immunoglobulin Therapy in Idiopathic Inflammatory Myositis in the Current Transformed Era of Biologics

“…Shahani reports successfully treating a 30-year-old patient with DM with painful calcinosis who failed steroid, and several DMARDs and responded to 2 gm/kg/month-IVIg over two consecutive days [49]. A survey on pediatric rheumatologist suggested that just over 1/4th rheumatologists perform initial screening imaging for calcinosis in newly diagnosed IIM patients.…”

Biologics in dermatology: An integrated review

“…The beneficial effect of IVIG in refractory, flared-up, rapidly progressive, or severe PM/DM has been documented in many open-label trials and reports (LOE2). [ 263 264 265 ]…”