P07: A rare case of perforating calcific elastosis, showing the importance of clinicopathological correlation

Sura Sahib, Laura Keeling, Julie Nichols and Sarah Cockayne

Sheffield Teaching Hospitals, Sheffield, UK

A 64-year-old multiparous woman on haemodialysis for chronic renal failure presented with a 15-month history of two subumbilical hyperpigmented violaceous indurated plaques associated with superficial ulceration, yellow serous discharge and mild discomfort. The largest measured 5 × 4 cm and had persisted despite the use of a topical steroid and antibiotic combination. The smaller lesion healed spontaneously within 3 weeks. She had multiple comorbidities, including a high body mass index (BMI) and diabetes mellitus. Skin biopsies showed fibrosed mid-/deep reticular dermis with prominent thickened, misshapen elastic fibres, some of which were calcified. The abnormal calcified elastic fibres extended to the upper reticular dermis close to the ulcer edge. No calcification of blood vessels was seen and there was a relative absence of the short frayed basophilic elastic fibres that are typically seen in pseudoxanthoma elasticum. Although the histological picture was not completely classical, the diagnosis of perforating calcific elastosis (PCE) was made based on correlation between clinical and histological features. PCE is rare with only 15 cases reported in the literature. It usually presents with periumbilical keratotic papules or hyperpigmented plaques in middle-aged multiparous high BMI women. This case brings attention to this rare diagnosis and highlights the importance of clinicopathological correlation and a close working relationship with the pathologist.