Leg Ulceration with Infected Calcinosis Cutis Mimicking Osteomyelitis: A Case Report

Purpose: The purpose of this case study is to highlight a patient with multiple recurrent episodes of sepsis and cellulitis that was ultimately diagnosed at calcinosis cutis of the lower extremity. Case Study: 93-year-old patient with a history of HTN, a-fib, squamous cell carcinoma of the right leg, sepsis from right leg cellulitis, that presented to the ED right leg erythema, abnormal warmth, edema, and with an anterior mid leg ulceration that measured to be 1 x 1 x 0.5 cm. There was no drainage, no purulence noted. She was sent by her podiatrist for concerns of osteomyelitis. Upon admission, her white blood cell count was 16.8k. Sepsis protocol was initiated. It was noted that the patient presented with multiple calcified nodules of the right lower extremity. At the time of admission, it was noted that one of the calcified nodules of the right anterior leg became infected and led to cellulitis. Radiographic imaging showed extensive calcifications in the leg with a sheet like appearance. MRI taken of the right lower extremity showed no abscess or osteomyelitis. Due to recurrent episodes of sepsis and cellulitis, the patient was taken to surgery for excision of calcified mass and biopsy. While in the hospital, the surgical site did not dehisce and there was evidence of decreased erythema and edema. Pathologic examination diagnosed the specimen as sclerotic fibroconnective tissue with acutely inflamed granulation tissue and calcification consistent with calcinosis cutis. She was discharged from the hospital and was seen weekly. Her wound dehisced and was treated with local debridement and collagen dressing. Eventually the wound fully healed. The wound remained healed for 18 months without complications. Analysis & Discussions: In conclusion, this case illustrates recurrent sepsis and cellulitis resolved with surgical excision of the calcinosis cutis lesions. Typically, foot and ankle specialist forego debridement of these calcified lesions, but because of the calcified nodules serving as a nidus of infection it was important for the patient to undergo surgical debridement. Overall, calcinosis cutis is difficult to treat with surgical excision as the mainstay of treatment.