{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:10:08Z","timestamp":1756278608387,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,1,31]]},"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:p>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\u2009mg\/dL (reference range: 8.5\u201310.1\u2009mg\/dL), ionised calcium was 1.70\u2009mg\/dL (reference range: 1.13\u20131.32\u2009mg\/dL) and 25-hydroxyvitamin D was 41.6\u2009ng\/mL (reference range 30\u2013100\u2009ng\/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\u2019s hypercalcaemia, calcinosis cutis diagnosis and management and the off-label use of denosumab.<\/jats:p>","DOI":"10.1136\/bcr-2017-223992","type":"journal-article","created":{"date-parts":[[2019,2,25]],"date-time":"2019-02-25T13:55:12Z","timestamp":1551102912000},"page":"e223992","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Metastatic calcinosis cutis due to refractory hypercalcaemia responsive to denosumab in a patient with multiple sclerosis"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3484-6197","authenticated-orcid":false,"given":"Ahmed","family":"Jorge","sequence":"first","affiliation":[{"name":"Department of Medicine, UPMC Mercy, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Szulawski","sequence":"additional","affiliation":[{"name":"Department of Medicine, UPMC Mercy, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fnu","family":"Abhishek","sequence":"additional","affiliation":[{"name":"Department of Medicine, UPMC Mercy, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,2,25]]},"reference":[{"key":"2025082623304280000_12.2.e223992.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.23.2832"},{"key":"2025082623304280000_12.2.e223992.2","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s40618-014-0235-x","article-title":"Calcium-phosphate metabolism in patients with multiple sclerosis","volume":"38","author":"Kubicka-Baczyk","year":"2015","journal-title":"J Endocrinol Invest"},{"key":"2025082623304280000_12.2.e223992.3","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2006.105320"},{"key":"2025082623304280000_12.2.e223992.4","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-13-15"},{"key":"2025082623304280000_12.2.e223992.5","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1080\/01616412.2016.1227913","article-title":"High dose Vitamin D intake and quality of life in relapsing-remitting multiple sclerosis: a randomized, double-blind, placebo-controlled clinical trial","volume":"38","author":"Ashtari","year":"2016","journal-title":"Neurol Res"},{"key":"2025082623304280000_12.2.e223992.6","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2005-0675"},{"key":"2025082623304280000_12.2.e223992.7","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2011.1199"},{"key":"2025082623304280000_12.2.e223992.8","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2012-2590","article-title":"Dietary reference intakes for calcium and vitamin D","volume":"130","year":"2012","journal-title":"Pediatrics"},{"key":"2025082623304280000_12.2.e223992.9","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70086-7"},{"key":"2025082623304280000_12.2.e223992.10","first-page":"1042","article-title":"A novel treatment for ulcerative calcinosis cutis","volume":"10","author":"Bair","year":"2011","journal-title":"J Drugs Dermatol"},{"key":"2025082623304280000_12.2.e223992.11","first-page":"55","article-title":"Pharmacological treatment in calcinosis cutis associated with connective-tissue diseases","volume":"52","author":"Dima","year":"2014","journal-title":"Rom J Intern Med"},{"key":"2025082623304280000_12.2.e223992.12","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1007\/s10067-004-1023-3","article-title":"Electric shock wave lithotripsy (ESWL) as a pain control measure in dermatomyositis with calcinosis cutis-old method, new discovery","volume":"24","author":"Chan","year":"2005","journal-title":"Clin Rheumatol"},{"key":"2025082623304280000_12.2.e223992.13","unstructured":"Amgen-Inc. Xgeva (denosumab). Prescribing Information. Thousand Oaks, CA, 2016."},{"key":"2025082623304280000_12.2.e223992.14","doi-asserted-by":"crossref","first-page":"3531","DOI":"10.1210\/jc.2013-4205","article-title":"Using denosumab to treat immobilization hypercalcemia in a post-acute care patient","volume":"99","author":"Booth","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"2025082623304280000_12.2.e223992.15","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2016-0192"},{"key":"2025082623304280000_12.2.e223992.16","doi-asserted-by":"publisher","DOI":"10.1007\/s10157-010-0362-4"},{"key":"2025082623304280000_12.2.e223992.17","first-page":"990","article-title":"Periarticular tumoral calcinosis and hypercalcemia in a hemodialysis patient without hyperparathyroidism: a case report","volume":"31","author":"Eisenberg","year":"1990","journal-title":"J Nucl Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-223992","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:30:53Z","timestamp":1756276253000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-223992"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2]]},"references-count":17,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,2,25]]},"published-print":{"date-parts":[[2019,2]]}},"alternative-id":["10.1136\/bcr-2017-223992"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-223992","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,2]]}}}