Soft-tissue infection and underlying calcinosis of CREST syndrome
Posted Sep 11 2009 4:57pm
Clinical Vistas Briefs by Navdeep Tangri and Barbara M. Young
A 55-year-old woman with a history of scleroderma presented after 5 days of experiencing fever, chills and progressive swelling of her right thumb. The thumb was exquisitely tender to touch. Wound cultures were obtained, and the patient's thumb was débrided. Cultures grew Staphylococcous aureus, and intravenous cloxacillin therapy was begun. Radiography of the hand ruled out bony involvement but demonstrated the typical appearance of calcinosis of CREST syndrome.
Calcinosis is one of the typical manifestations of CREST syndrome. The other features include Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia. Our patient had all of these features except for telangiectasia. The calcinosis results from deposition of amorphous calcium hydroxyapatite crystals in the skin, soft tissue or muscles. Local or systemic inflammatory factors are thought to mediate calcium precipitation. Superinfection can occur and often requires antibiotics and surgical débridement.