Role of activated macrophage and inflammatory cytokines in the development of calcinosis in juvenile dermatomyositis

摘要

Sir, A 22-year-old male presented with multiple cutaneous calcinosis and ulceration on his buttocks. He had been diagnosed with juvenile dermatomyositis (JDM) 10 years previously. No myositis-specific antibodies or myositis-associated antibodies were detected by immunoprecipi-tation. He had received treatment involving high doses of prednisolone and i.v. immunoglobulin and various im-munosuppressive drugs such as ciclosporin, AZA, MMF and tacrolimus. However, his symptoms relapsed on weaning from prednisolone. Although rituximab had effectively treated his skin manifestations and muscle weakness, the calcinosis remained unchanged. Physical examination revealed a tender firm nodule with a central ulceration surrounded by erythematous skin, measuring up to 50 mm in diameter, on his buttocks. Radiological examination with CT demonstrated numerous superficial and deep calcium deposits over his entire body. Large tumorous deposits of calcium, which appeared as popcorn-like areas, were observed on the buttocks and were subsequently removed surgically.