Research Article
Volume 3 Issue 6 - 2020
Dermatomyositis Complicated by Calcinosis: Keys to the Therapeutic Challenge
Aamir Jalal Al Mosawi1,2*
1Advisor in Pediatrics and Pediatric Psychiatry, Children Teaching Hospital of Baghdad Medical City, Baghdad, Iraq
2Head, Iraq Headquarter of Copernicus Scientists International Panel, Baghdad, Iraq
*Corresponding Author: Aamir Jalal Al Mosawi, Advisor in Pediatrics and Pediatric Psychiatry, Children Teaching Hospital of Baghdad Medical City and Head, Iraq Headquarter of Copernicus Scientists International Panel, Baghdad, Iraq.
Received: May 05, 2020; Published: May 22, 2020


Background: There is no curative therapy for dermatomyositis complicated by calcinosis. Many patients with such disorders will continue to have some symptoms. In Iraq many specialist physicians may have limited experience with treatment of such disorders and treatment side effects of log term treatment can be sometimes encountered. It is hoped that advances associated with the accumulating research evidence can help in improving treatment of such conditions.

Materials and Methods: A unique case of pediatric dermatomyositis associated with calcinosis that was referred because treatment was unsatisfactory and was associated with serious side effects was studied. The medical literatures were reviewed for the research evidence suggesting possible therapeutic interventions than improve this condition.

Results: The occurrence of pediatric dermatomyositis associated with calcinosis has not been well documented in Iraq. RH is an eight-year old who had dermatomyositis associated with calcinosis and complicated by bilateral osteonecrosis of the hip joints, pericardial effusion, and chronic hematoma at the right ankle. The girl was treated before referral by some of the traditional therapies that improved her symptoms early in the course of illness, but treatment was associated remissions and relapses and she experienced serious side effects of long-term treatment.

Conclusion: Research evidence suggests several possible therapies for the treatment of dermatomyositis complicated calcinosis despite long-term prednisolone and methotrexate. The choice of the option may have to be individualized as it may depend on the experience of the treating physician, the availability of the medications. As a first line we suggest the use of Adrenocorticotropic hormone (ACTH) combined with probenecid and aluminium hydroxide as a first line.

Keywords: Dermatomyositis; Calcinosis; Osteonecrosis of Hips; Pericardial Effusion


  1. Bailey RH. “Dermatomyositis complicated by Calcinosis”. Proceedings of the Royal Society of Medicine 10 (1938): 1153-1154.
  2. Bitnum S., et al. “Dermatomyositis”. The Journal of Pediatrics 64 (1964): 101-131.
  3. Wallace HJ. “Calcinosis cutis? Old dermatomyositis”. Proceedings of the Royal Society of Medicine 57 (1964): 317-319.
  4. Dupuis M and Sironi C. “A case of diffused calcinosis in a 2-month-old infant”. Minerva Pediatrica 4 (1970): 223-229.
  5. Hill RH and Wood WS. “Juvenile dermatomyositis”. The Canadian Medical Association Journal 11 (1970): 1152-1156.
  6. Debre R., et al. “Dermatomyositis with slow evolution and calcification; favorable effect of ACTH”. Archives Francaises de Pediatrie 6 (1953): 619-626.
  7. Nassim JR and Connolly CK. “Treatment of calcinosis universalis with aluminium hydroxide”. Archives of Disease in Childhood 239 (1970): 118-121.
  8. Nakagawa T and Takaiwa T. “Calcinosis cutis in juvenile dermatomyositis responsive to aluminum hydroxide treatment”. Journal of Dermatology 9 (1993): 558-560.
  9. Godeau P., et al. “Calcinosis universalis associated with dermatomyositis. A report on five cases”. Sem Hop45 (1980): 1871-1875.
  10. Skuterud E., et al. “Calcinosis in dermatomyositis treated with probenecid”. The Scandinavian Journal of Rheumatology 2 (1981): 92-94.
  11. Harel L., et al. “Treatment of calcinosis in juvenile dermatomyositis with probenecid: the role of phosphorus metabolism in the development of calcifications”. The Journal of Rheumatology 5 (2001): 1129-1132.
  12. Nakamura H., et al. “Efficacy of probenecid for a patient with juvenile dermatomyositis complicated with calcinosis”. The Journal of Rheumatology 8 (2006): 1691-1693.
  13. Fuchs D., et al. “Colchicine suppression of local inflammation due to calcinosis in dermatomyositis and progressive systemic sclerosis”. Clinical Rheumatology 4 (1986): 527-530.
  14. Oliveri MB., et al. “Regression of calcinosis during diltiazem treatment in juvenile dermatomyositis”. Clinical Rheumatology 12 (1996): 2152-2155.
  15. Ichiki Y., et al. “An extremely severe case of cutaneous calcinosis with juvenile dermatomyositis, and successful treatment with diltiazem”. British Journal of Dermatology 4 (2001): 894-897.
  16. Jiang X., et al. “A case of juvenile dermatomyositis with severe calcinosis and successful treatment with prednisone and diltiazem”. International Journal of Dermatology 1 (2011): 74-77.
  17. Ambler GR., et al. “Rapid improvement of calcinosis in juvenile dermatomyositis with alendronate therapy”. The Journal of Rheumatology 9 (2005): 1837-1839.
  18. Riley P., et al. “Effectiveness of infliximab in the treatment of refractory juvenile dermatomyositis with calcinosis”. Rheumatology 6 (2008): 877-880.
  19. Marco Puche A., et al. “Effectiveness of the treatment with intravenous pamidronate in calcinosis in juvenile dermatomyositis”. Clinical and Experimental Rheumatology 1 (2010): 135-140.
  20. Martillotti J., et al. “Improvement of calcinosis using pamidronate in a patient with juvenile dermatomyositis”. Pediatric Radiology 1 (2014): 115-118.
  21. Palaniappan P., et al. “Successful treatment of calcinosis cutis in juvenile dermatomyositis with pamidronate”. Journal of Clinical Rheumatology 8 (2014): 454-455.
  22. Giri S., et al. “Pamidronate in treatment of calcinosis in juvenile dermatomyositis”. Indian Pediatrics 1 (2020): 75-76.
  23. Al-Mayouf SM., et al. “Localized calcinosis in juvenile dermatomyositis: successful treatment with intralesional corticosteroids injection”. International Journal of Rheumatic Diseases 3 (2010): e26-e28.
  24. Touimy M., et al. “Calcinosis universalis complicating juvenile dermatomyositis: improvement after intravenous immunoglobulin therapy”. Joint Bone Spine1 (2013): 108-109.
  25. Pagnini I., et al. “Sodium thiosulfate for the treatment of calcinosis secondary to juvenile dermatomyositis”. Clinical and Experimental Rheumatology 3 (2014):408-409.
Citation: Aamir Jalal Al Mosawi. “Dermatomyositis Complicated by Calcinosis: Keys to the Therapeutic Challenge”. EC Clinical and Medical Case Reports 3.6 (2020): 97-102.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

July Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the July issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before July 15, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.