PMC9947514_01
Systemic involvement of scleromyositis. A and B: extensive calcinosis of the left and right elbow (arrows). C: MRI showing signs of cutaneous thickening with hypersignal of trabeculated aspect in long TR sequences (arrow). No involvement of muscle or bone planes. Small calcinosis plaques in dermis. D: Signal alteration of the subcutaneous cellular tissue in the form of hyposignal T1 compatible with cellulitis (arrow). Small calcinosis plaques in dermis. E: High-resolution CT scan showing bilateral pleuroapical thickening and paraseptal emphysema predominantly in the lower lobes and isolated areas of ground glass. F: Cardiac MRI 2021, diffuse myocardial inflammation with elevated T1 and T2 mapping, normal STIR with no evidence of fibrosis (arrow). G: Cardiac MRI 2022, no pathologic enhancements or evidence of inflammation or diffuse fibrosis.
cureus-0015-00000034125-i01.jpg
PMC9947514_01_cureus-0015-00000034125-i01.jpg
FIG1
High-resolution pulmonary CT revealed interstitial lung disease with paraseptal emphysema and ground glass (Figure 1). Cardiac MRI showed low-grade diffuse myocardial inflammation (in T1 and T2 mapping, with normal STIR) without areas of regional fibrosis compatible with myocarditis (Figure 1).  Regarding myocarditis, usTnI and NTproBNP normalized (33.7 ng/L and <35 pg/mL, respectively) 3-4 months after the start of tofacitinib, and cardiac MRI at one year evidenced resolution of inflammatory infiltrates without residual fibrosis (Figure 1).
Nailfold capillaroscopy (200x) evolution. 2A: Nailfold capillaroscopy 2020: capillary loss with avascular areas (line), frequent branching, and arborizations without dilatations, hemorrhages, or megacapillaries. 2B: Nailfold capillaroscopy 2022: partial recovery of the capillary bed but with neoangiogenesis pattern, dilatations (arrow), and arborescent branching without hemorrhages.
cureus-0015-00000034125-i02.jpg
PMC9947514_01_cureus-0015-00000034125-i02.jpg
FIG2
He had Raynaud's phenomenon with numerous avascular areas, frequent branching, and arborization in nailfold capillaroscopy (Figure 2). Control nailfold capillaroscopy (Figure 2) showed improvement of the avascular areas without hemorrhages and persistence of branching and arborization of capillaries.
Improvement of calcinosis after treatment . 1A: Before tofacitinib. 1B: After tofacitinib.
cureus-0015-00000034125-i03.jpg
PMC9947514_01_cureus-0015-00000034125-i03.jpg
FIG3
Despite all these treatments, in the year 2021, he presented a progression of calcinosis (Figure 3) in the shoulders, elbows, and thighs, requiring several local cures for skin exposure by the Dermatology Department and hospital admission for skin and soft tissue infection associated with calcinosis of the elbow. A clinical decrease in the extent of calcinosis has been observed, especially at both elbows (Figure 3).