Article Text

Metastatic calcinosis cutis due to refractory hypercalcaemia responsive to denosumab in a patient with multiple sclerosis
  1. Ahmed Jorge,
  2. Robert Szulawski and
  3. Fnu Abhishek
  1. Department of Medicine, UPMC Mercy, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Ahmed Jorge, jorgea{at}


Metastatic calcinosis cutis results from abnormal calcium levels leading to the precipitation of insoluble calcium salts in the skin and subcutaneous tissue. Here, we present the case of a 67-year-old man with multiple sclerosis on chronic dexamethasone and concurrent supplementation of calcium and daily cholecalciferol presenting with painful calcified lesions. During initial presentation, corrected calcium was 13.8 mg/dL (reference range: 8.5–10.1 mg/dL), ionised calcium was 1.70 mg/dL (reference range: 1.13–1.32 mg/dL) and 25-hydroxyvitamin D was 41.6 ng/mL (reference range 30–100 ng/mL). Normocalcaemia was restored with the off-label use of denosumab, usually reserved for hypercalcaemia of malignancy and intractable osteoporosis. We discuss potential aetiologies of this patient’s hypercalcaemia, calcinosis cutis diagnosis and management and the off-label use of denosumab.

  • vitamins and supplements
  • multiple sclerosis
  • calcium and bone
  • metabolic disorders
  • dermatology
View Full Text

Statistics from


  • Contributors AJ was involved in the conception, writing and editing of this manuscript and performed the literature search and patient history, physical exam and laboratory data collection. RS was involved in the writing and revision of this manuscript. He was also an excellent resource to discuss different ways of writing about this case. AF was involved in the discussion of planning, interpretation of data, writing and revision of this manuscript. All authors have approved the manuscript as it is written.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.