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Research ArticleImages in Rheumatology

Spinal Stenosis Caused by Calcinosis in a Patient With Systemic Sclerosis

Tal Gazitt, Joy Feld and Devy Zisman
The Journal of Rheumatology September 2021, 48 (9) 1488-1489; DOI: https://doi.org/10.3899/jrheum.201389
Tal Gazitt
Rheumatology Unit, Carmel Medical Center, Haifa
MD, MSc
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  • For correspondence: tgazitt@gmail.com
Joy Feld
Rheumatology Unit, Carmel Medical Center, Haifa
MD, MSc
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Devy Zisman
Division Head, Rheumatology Unit, Carmel Medical Center, and The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Roles: MD
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Calcinosis or dystrophic soft-tissue calcification occurs in damaged/devitalized tissues in the presence of normal calcium/phosphorus metabolism.1 It is a known complication of connective tissues diseases, especially juvenile dermatomyositis and systemic sclerosis (SSc), and may be localized or widespread.2 Previous data from the Scleroderma Clinical Trials Consortium showed calcinosis to be most commonly associated with digital ulceration, osteoporosis, telangiectasias, and acroosteolysis,3 as well as with anticentromere, anti-PM/Scl, and anticardiolipin antibodies.3 While calcinotic accumulations typically occur at pressure sites,1,4 here we present an unusual case of calcinosis affecting the spinal canal.

A 63 year-old woman with a history of osteoporosis was diagnosed with diffuse SSc based on puffy hands, Raynaud phenomenon, sclerodactyly, sclerodermatous skin changes affecting both arms, and positive antinuclear antibody with a nucleolar pattern and anti-Scl70. No telangiectasias or calcinosis were apparent on exam. Following initial diagnosis, she started complaining of low back pain radiating to her left leg. Computed tomography (CT) scan revealed a calcified lesion in the left facet joint at L5–S1 level protruding centrally into the spinal cord and causing severe spinal stenosis; there were no additional visceral/retroperitoneal abnormalities (Figure 1A,B). Magnetic resonance imaging of the spine demonstrated similar findings. The lesion was totally resected laparoscopically with resolution of her symptoms. Pathologic examination of the resected specimen showed calcified mass.

Figure 1.
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Figure 1.

(A) Axial contrast-enhanced CT image of the spine showing protruding calcified masses (white arrow) arising from the left facet joint, compressing the left L5 nerve root (arrowhead). (B) Sagittal contrast-enhanced CT image showing intraspinal calcific masses (curved white arrow) causing spinal stenosis. CT: computed tomography.

Although dystrophic soft-tissue calcification is known to complicate SSc and may involve the vertebral column, it rarely causes cervical or lumbar spinal cord compression requiring surgical intervention, as in this case.

ACKNOWLEDGMENT

The authors would like to acknowledge musculoskeletal radiologist Dr. Najwan Nassrallah for her help with the CT image presented in this case.

Footnotes

  • The authors declare no conflicts of interest. Ethics board approval was not required by the authors’ institution because this is a single anonymous case report and no intervention had been made for research. The patient’s written informed consent to publish the material was obtained.

  • © 2021 by the Journal of Rheumatology

REFERENCES

  1. 1.↵
    1. Boulman N,
    2. Slobodin G,
    3. Rozenbaum M,
    4. Rosner I
    . Calcinosis in rheumatic diseases. Semin Arthritis Rheum 2005;34:805-12.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Chander S,
    2. Gordon P
    . Soft tissue and subcutaneous calcification in connective tissue diseases. Curr Opin Rheumatol 2012;24:158-64.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Valenzuela A,
    2. Baron M, Canadian Scleroderma Research Group,
    3. Herrick AL,
    4. Proudman S,
    5. Stevens W, et al.
    Calcinosis is associated with digital ulcers and osteoporosis in patients with systemic sclerosis: a Scleroderma Clinical Trials Consortium study. Semin Arthritis Rheum 2016;46:344-9.
    OpenUrl
  4. 4.↵
    1. Yehudina YD,
    2. Golovach IY
    . Calcinosis in systemic sclerosis: prevalence, clinical picture, management, complications. Pain Joints Spint 2019;9:108-19.
    OpenUrl
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Spinal Stenosis Caused by Calcinosis in a Patient With Systemic Sclerosis
Tal Gazitt, Joy Feld, Devy Zisman
The Journal of Rheumatology Sep 2021, 48 (9) 1488-1489; DOI: 10.3899/jrheum.201389

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Spinal Stenosis Caused by Calcinosis in a Patient With Systemic Sclerosis
Tal Gazitt, Joy Feld, Devy Zisman
The Journal of Rheumatology Sep 2021, 48 (9) 1488-1489; DOI: 10.3899/jrheum.201389
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