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Abstract

Calcinosis universalis is a rare condition characterized by calcium deposition in the skin, subcutaneous tissue, muscles, and tendons, often associated with dermatomyositis. While uncommon, pseudofungal structures can be observed histologically in calcified lesions, resembling fungal organisms and posing a diagnostic challenge. We present a case of a 33-year-old female with a history of dermatomyositis (diagnosed at age 9), calcinosis universalis, diabetes mellitus, pancreatitis, and restrictive lung disease. She developed a large, ulcerated mass on the left abdomen and flank secondary to calcium deposition and underwent surgical excision. Histopathologic examination of the lesion revealed calcium and bone deposition within the dermis and subcutaneous tissue, consistent with calcinosis universalis. On higher magnification, fungal-like hyphae and yeast-like structures were identified within the bone and calcified areas, raising suspicion for fungal infection. However, special fungal stains, including GMS and PAS/F, were negative, confirming these structures as pseudofungal artifacts rather than true fungal organisms.This case underscores the importance of recognizing pseudofungal elements in calcified lesions to avoid misdiagnosis and unnecessary antifungal treatment. Correlation of routine histology with special stains is critical in distinguishing true fungal infections from mimics. Although rare, pseudofungal structures within calcified lesions highlight an important diagnostic pitfall that dermatopathologists should be aware of. This case adds to the literature emphasizing the need for careful histologic and clinical correlation in the evaluation of calcified cutaneous lesions.