Uremic tumoral calcinosis: Case report

Abstract

Introduction: Tumoral calcinosis (TC) is a rare condition characterized by the deposition of calcium pyrophosphates in periarticular soft tissues. When TC occurs in the context of chronic kidney disease (CKD), it is known as uremic TC.

Case Presentation: A 52-year-old male with a history of type II diabetes, CKD on dialysis, and secondary hyperparathyroidism (under treatment with cinacalcet for the last 6 months), attended the orthopedic outpatient service of a quaternary care hospital in Medellin (Colombia) due to a large mass in the left shoulder that appeared 3 months earlier and limited the functionality of that joint. Physical examination revealed a painless mass with no inflammatory signs. Laboratory tests on admission showed hypercalcemia, hyperphosphatemia, and elevated levels of parathyroid hormone (PTH), while imaging tests showed a multilobulated, encapsulated mass with calcifications, but no bone involvement (X-ray and ultrasound of the shoulder), as well as enlarged parathyroid glands (ultrasound). Smaller but similar lesions were also identified in the interphalangeal joints of the left hand and in the soft tissues of the left foot. Based on these findings, he was diagnosed with TC secondary to uncontrolled tertiary hyperparathyroidism, leading to subtotal parathyroidectomy to control hypercalcemia as an indirect treatment of the periarticular lesions. In a follow-up appointment 3 months after the procedure, a reduction of the shoulder mass size (at least 20%) and improvement of the ranges of motion were observed.

Conclusion: This case highlights the importance of considering secondary TC as a differential diagnosis in CKD patients on dialysis who present with progressively enlarging periarticular masses. Given its frequent association with hyperparathyroidism, constant monitoring of PTH is essential for a timely diagnosis.