Efficacy of intralesional sodium thiosulfate injections for disabling tumoral calcinosis: Two cases.

Abstract

INTRODUCTION:

Tumoral calcinosis (TC) is a difficult-to-treat complication that can occur during several diseases such as dermatomyositis or genetic hyperphosphatemia. It is a painful and disabling condition that can lead to local complications including joint mobility reduction, cutaneous ulceration and superinfection. For the largest lesions, the treatment relies essentially on surgery. Intravenous sodium thiosulfate (STS) is efficient to treat calciphylaxis in patients undergoing hemodialysis. Local injections of STS seem efficient in superficial calcifications.

OBJECTIVE:

To report the efficacy and safety of intra-lesional injections of STS in tumoral calcinosis.

RESULTS:

We report two cases of successful intra-lesional injections of STS. A 44-year-old woman, with a history of dermatomyositis, presenting large subcutaneous calcifications in the right elbow, and a 42-year-old man, with a history of familial tumoral calcinosis, presenting large intramuscular calcifications in the right buttock, received weekly intra-lesional of 1-3g STS injections for 12 and 21 months, respectively. In both cases, the treatment relieved pain and greatly reduced the tumoral calcinosis with a very significant functional improvement without specific adverse effects. In case 1, TC size decreased from 28.7*56.0mm at baseline to 21.5*30.6mm at M12 treatment (59% reduction). In case 2, TC reduced from 167.5*204.3mm at baseline to 86.2*85.2mm at M21 treatment (79% reduction).

CONCLUSION:

Local injection of STS could be a promising therapeutic strategy for large and deep TC lesions and could therefore be an alternative to surgery.

• Authors: J Goossens, M Courbebaisse, E Caudron, C Bahans, V Vacquerie, J Melchior, P Vergne Salle, C Moesch, M Daudon, V Frocht, P Richette, Hang-Korng Ea, V Guigonis
• Journal: Seminars in arthritis and rheumatism (Semin Arthritis Rheum) Vol. 47 Issue 3 Pg. 451-455 (12 2017) ISSN: 1532-866X [Electronic] United States
• PMID: 28779847 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Chemical References

• Chelating Agents
• FGF23 protein, human
• Thiosulfates
• Fibroblast Growth Factor-23
• sodium thiosulfate

Topics

• Adult
• Calcinosis (drug therapy, etiology)
• Chelating Agents (administration & dosage)
• Dermatomyositis (complications, diagnostic imaging, drug therapy)
• Female
• Fibroblast Growth Factor-23
• Humans
• Hyperphosphatemia (complications, drug therapy, genetics)
• Injections, Intralesional
• Magnetic Resonance Imaging
• Male
• Sjogren's Syndrome (complications)
• Thiosulfates (administration & dosage)