Milk of calcium in scleromyositis

Abstract

Figures

a–d](#keaf568-F1)). The patient was treated with MTX for 4 years, then discontinued for clinical stability. When she turned 23 years old, she complained of diffuse, mild muscle pain, with a slight increase in creatine phosphokinase levels. Thus, she underwent a whole-body MR which demonstrated the persistence of fluid collection with calcific rim ([Fig. 1e–g](#keaf568-F1)) and increased soft tissue calcifications in the extremities.

Full text

A 15-year-old female with scleromyositis (Anti-PM/Scl 75 and 100) characterized by sclerodactyly, calcinosis, telangiectasia and myositis, reported a slow-growing lump in the right thigh. A CT scan showed multiple calcifications and a fluid collection with a calcific rim in the vastus medialis, suggestive of ‘milk of calcium’ calcinosis (Fig. 1a–d). The patient was treated with MTX for 4 years, then discontinued for clinical stability. When she turned 23 years old, she complained of diffuse, mild muscle pain, with a slight increase in creatine phosphokinase levels. Thus, she underwent a whole-body MR which demonstrated the persistence of fluid collection with calcific rim (Fig. 1e–g) and increased soft tissue calcifications in the extremities.

Scleromyositis is an overlap syndrome that has not been completely characterized. The so-called ‘milk of calcium’ is a rare type of calcinosis, and only a few cases have reported its imaging features [1, 2]. Unfortunately, there is no effective therapy for calcinosis, with anecdotal reports about Janus kinase (JAK) inhibitors for myositis.

To the best of our knowledge, this is the first case showing MR and CT imaging of the ‘milk of calcium’ calcinosis in scleromyositis over time, demonstrating that both are suitable tools for assessing this rare and disabling manifestation of the disease.