Multiple Differential Diagnoses Research Articles

Management and treatment of perioperative hypersensitivity.

Perioperative hypersensitivity reactions are rare but potentially catastrophic events. This review acts to summarize recent recommendations for both immediate and poststabilization management of suspected reactions, alongside practical advice for anaesthetists who may be faced with these events. Prompt treatment is essential but may be hampered by delay in recognition. This can occur because there are multiple differential diagnoses for the observed clinical signs as well as variations in clinical presentation. Resuscitation is dependent on the use of adrenaline and fluids. Adrenaline should be administered in small, titrated intravenous boluses. Low-dose infusions should be commenced early if the response to boluses is poor. Large volume fluid resuscitation may be required to maintain adequate circulating volume. Chest compressions are recommended when there is evidence of inadequate perfusion, rather than waiting until cardiac arrest is confirmed. Antihistamines and corticosteroids are no longer recommended in the immediate management phase. Once the patient has been stabilized, it is important to obtain serial tryptase concentrations to aid the subsequent clinic investigation. The decision to proceed or abandon surgery will be based on an individual risk-benefit analysis. All cases of suspected perioperative hypersensitivity, including fatal cases, must be referred for formal investigation. There have been recent updates to management guidelines in perioperative hypersensitivity. Treatment algorithms, treatment packs and referral packs can all help the anaesthetist manage these complex cases, aid the subsequent investigation and ensure patient safety in the future.

Exploring the diverse phenotypes of anti-GAD 65 encephalitis, diagnosis and treatment challenges

Objectives. To present two cases of anti-glutamic acid decarboxylase 65 (anti-GAD65) antibody encephalitis with different clinical phenotypes. Introduction. Anti-glutamic acid decarboxylase 65 antibody encephalitis (GAD-65 AE) is a rare pathology with a high potential for severity, having multiple forms of presentation and multiple differential diagnoses. This presentation aims to exemplify the strong clinical heterogeneity that is associated with this clinical entity by putting forth two cases that were treated in our clinic, each representing a separate clinical phenotype of this pathology. Material and methods. We analyzed two cases from our clinic of autoimmune encephalitis with positive anti-GAD65 antibodies and compared the cases with the data from the literature regarding clinical presentation, differential diagnosis, treatment, and evolution. Content. The first case presented is a woman aged 71 (66 at onset) presenting with progressive cerebellar ataxia. She was diagnosed with GAD-65 AE based on clinical presentation and positive anti-GAD65 antibodies titer. She was initially treated with methylprednisolone pulse therapy and received four such courses in the first year after diagnosis, resulting in a slowing of the progression of the neurological deficit. During the COVID19 pandemic, treatment was paused and her neurological status resumed its decline, and she also developed insulin-dependent diabetes mellitus. Starting in 2021, treatment was continued, having received one course of IVIg and one course of plasma exchange in our clinic. Eventually, the treatment was switched to Mycophenolate mofetil but her status continues to decline. The second case is about a 32 years old woman, with a history of recurrent seizures and progressive memory decline that started at 28 years. She was diagnosed 11 months after the onset with limbic encephalitis with anti-GAD65 antibodies, left temporal focal epilepsy with nocturnal seizures and mild cognitive decline. She was treated with corticotherapy and IgG. She was discharged home with antiepileptic treatment with no recurring seizures, but a slow cognitive decline. She had two relapses at distance from the onset, the first one with status epilepticus and the second one with focal seizures and a generalized seizure. She developed type I diabetes with positive anti-pancreatic islet antibodies. After the first relapse, immunosuppressive therapy with Mycophenolate mofetil was initiated. The evolution was good and under immunosuppression she had only one episode of seizures in the context of a COVID-19 infection. Conclusions. Autoimmune encephalitis with positive GAD antibodies presents a very diverse clinical picture, as we can see in the presented cases.

Carotid body tumors: a review

Carotid body tumor or paraganglioma, is located periadventitially in relation to the carotid bifurcation. Generally, the blood supply of carotid tumors is abundant, it comes mainly from the branches of the external carotid arteries, although cases have been reported where the irrigation comes from the internal carotid artery, vertebral artery, ascending pharyngeal artery and superior thyroid. Although its etiology is unknown, different factors have been associated that contribute to its incidence, such as genetic factors and states of chronic hypoxia. Histologically, they are well vascularized tumors. Between the capillaries there are groups of tumor cells known as Zellballen's pseudoalveolar pattern. These are cells with eosinophilic granular cytoplasm and small round or oval nuclei. The tumor is mobile, but with limitation to mobilization in the cephalocaudal direction. The mass can transmit the carotid pulse due to its proximity to the carotid, and it may also be accompanied by a murmur or thrill. Usually the carotid glomus is identified by clinical examination, so consideration of multiple differential diagnoses. The treatment of choice is surgical excision. The need for preoperative embolization is controversial. Embolization before surgery is recommended to improve surgical success with reduced blood loss as well as reduce the risk of cranial nerve injury. The decision to perform presurgical embolization or not depends on the surgeon.

An artificial intelligence approach for investigating multifactorial pain-related features of endometriosis.

Endometriosis is a debilitating, chronic disease that is estimated to affect 11% of reproductive-age women. Diagnosis of endometriosis is difficult with diagnostic delays of up to 12 years reported. These delays can negatively impact health and quality of life. Vague, nonspecific symptoms, like pain, with multiple differential diagnoses contribute to the difficulty of diagnosis. By investigating previously imprecise symptoms of pain, we sought to clarify distinct pain symptoms indicative of endometriosis, using an artificial intelligence-based approach. We used data from 473 women undergoing laparoscopy or laparotomy for a variety of surgical indications. Multiple anatomical pain locations were clustered based on the associations across samples to increase the power in the probability calculations. A Bayesian network was developed using pain-related features, subfertility, and diagnoses. Univariable and multivariable analyses were performed by querying the network for the relative risk of a postoperative diagnosis, given the presence of different symptoms. Performance and sensitivity analyses demonstrated the advantages of Bayesian network analysis over traditional statistical techniques. Clustering grouped the 155 anatomical sites of pain into 15 pain locations. After pruning, the final Bayesian network included 18 nodes. The presence of any pain-related feature increased the relative risk of endometriosis (p-value < 0.001). The constellation of chronic pelvic pain, subfertility, and dyspareunia resulted in the greatest increase in the relative risk of endometriosis. The performance and sensitivity analyses demonstrated that the Bayesian network could identify and analyze more significant associations with endometriosis than traditional statistical techniques. Pelvic pain, frequently associated with endometriosis, is a common and vague symptom. Our Bayesian network for the study of pain-related features of endometriosis revealed specific pain locations and pain types that potentially forecast the diagnosis of endometriosis.

Reactivation of Tumor-like Chagas Disease in the Central Nervous System in Cardiac Transplant Patients: A Case Series and Literature Review

Abstract Introduction Chagas disease is an important public health problem in Latin American countries, affecting ∼ 6 million people within the region. In patients with chronic Chagas disease who undergo some type of immunosuppression reactivation of the acute form may occur, and manifestations involve many organs, including the central nervous system. Tumor-like brain reactivations are well described in patients with acquired immunodeficiency syndrome; however, this is a very rare event among Chagasic patients immunosuppressed after a heart transplantation. Case Report We describe three cases of cardiac transplant patients who had a tumor-like intracranial lesion, whose biopsies were compatible with Chagas disease. All 3 patients were treated with benznidazole, and 2 of them presented parameters of cure after 60 days of treatment, while 1 required a 2nd cycle of treatment. Discussion A tumor-like Chagas disease reactivation in the central nervous system may happen in heart-transplant patients and, due to the multiple differential diagnoses, we believe that brain biopsies should be considered when feasible.

Tuberculosis Mimicking-Musculoskeletal Tumor of The Hand: An Uncommon Case of Extrapulmonary Tuberculosis

Background: Musculoskeletal extrapulmonary tuberculosis is accounting for only 10-15% of all cases. Current attention has been focused on hand tuberculosis due to its increasing prevalence. This study describes an unusual case of extrapulmonary tuberculosis that manifested as a soft tissue tumor of the hand.Case Report: A 17-year-old male presented with a painful swollen part of the 3rd finger of the left hand. The mass was irregular and suppurative, with discoloration and foul smell. Laboratory results showed anemia and increased erythrocyte sedimentation rate. The computed tomography scan showed an isodense soft tissue (size 2.19 cm x 1.59 cm x 4.21cm) across the distal to the proximal part of 3rd phalanx bone to the metacarpal region with a decrease of phalanx bone density with no sign of bone destruction or any periosteal reaction. The histopathology study revealed a chronic granulomatous structure surrounded by epitheloid cells, datia Langhans cells, and caseating necrosis. The acid-fast staining confirmed the presence of bacilliform bacteria.Discussion: Extrapulmonary tuberculosis typically results from secondary hematogenous dissemination and reactivation of the main foci. There are no specific tests to diagnose musculoskeletal tuberculosis preoperatively, leading to delayed diagnosis. Histopathological examination and culture are needed to confirm the diagnosis.Conclusions: Slow progression and multiple differential diagnoses frequently result in a delayed diagnosis, which leads to complications. Initial radical excision and anti-tuberculosis multidrug therapy provide excellent functional outcomes and recurrence prevention.

A large retroperitoneal mass in a elderly male: A case report

Pain abdomen and distention of abdomen in elderly male, which is chronic in nature, draws attention to multiple differential diagnoses, especially if the individual has multiple comorbidities in the form of Systemic Hypertention, dyslipidemia. Ruling out aortic, renal, and gut pathologies clinically, biochemically and radiologically, the suspicion increases towards the intra-abdominal pathology [1]. The patient initially had swelling in left hypochondriac area which gradually increased over a period of 12 years and extended towards both lumbar regions and right iliac fossa associated with dull aching pain around left hypochondriac area [2]. Patient denied history of previous abdominal surgeries. Surgical removal is treatment of choice for a symptomatic patient with retroperitoneal mass. However, the controversy surrounding the surgical removal goes with histopathological outcome of the specimen [3]. As a norm the retroperitoneal tumors are slow growing and the chances of malignant transformation increases with size and duration, high suspicion of sarcomatous transformational pathology should be kept in mind [4].

Pediatric Multiple Sclerosis: Changing the Trajectory of Progression.

Multiple sclerosis is a chronic inflammatory disease of the central nervous system. When seen in children and adolescents, crucial stages of brain development and maturation may be affected. Prompt recognition of multiple sclerosis in this population is essential, as early intervention with disease-modifying therapies may change developmental trajectories associated with the disease. In this paper, we will review diagnostic criteria for pediatric multiple sclerosis, outcomes, differential diagnosis, and current therapeutic approaches. Recent studies have demonstrated the utility of newer structural and functional metrics in facilitating early recognition and diagnosis of pediatric MS. Knowledge about disease-modifying therapies in pediatric multiple sclerosis has expanded in recent years: important developmental impacts of earlier therapeutic intervention and use of highly effective therapies have been demonstrated. Pediatric MS is characterized by highly active disease and high disease burden. Advances in knowledge have led to early identification, diagnosis, and treatment. Lifestyle-related interventions and higher efficacy therapies are currently undergoing investigation.

Adrenal pseudo cyst presenting as retroperitoneal lesion: a rare presentation

Adrenal pseudocyst are cystic lesions arising from the adrenal gland and do not contain any definitive epithelial lining. These are extremely rare and very few cases are reported, representing 1-2% of adrenal incidentalomas. Patients generally have a non-specific presentation with most patients being asymptomatic and detected incidentally, while others may present with the ensuing mass symptoms in cases of large cysts. Multiple differential diagnosis may be considered for the same. Here we reported the case of a 43 year old female who presented to us with worsening pain abdomen in the left upper quadrant. An ultrasonography revealed an 8×9×9 cm cystic lesion in the region of the tail of pancreas. Subsequent CT was suggestive of a retroperitoneal cyst with multiple diagnostic possibilities owing to the many intra-abdominal structures it was found to be associated with. A definitive pre-operative diagnosis regarding the origin of the cystic swelling could not be made. A decision to remove the lesion operatively via an open approach through an upper midline laparotomy was made and eventual histopathological diagnosis confirmed it to be an adrenal pseudocyst.

Hemicraniectomia decompresiva en un paciente de 5 años con ataque cerebrovascular isquémico en el territorio de la arteria cerebral media derecha: presentación de caso clínico y revisión de la literatura

El ataque cerebrovascular (ACV) isquémico en la infancia es una entidad poco común que se ha venido incrementando en frecuencia y representa una patología de alto riesgo de eventos adversos en los niños; adicionalmente, es una patología de difícil manejo y con múltiples recurrencias. Los pacientes pediátricos que presentan esta clase de patología y que llegan al servicio de urgencias pediátricas son difíciles para establecer un diagnóstico e instaurar un manejo rápido, ya que esta entidad presenta múltiples diagnósticos diferenciales y por su baja incidencia no se tienen algoritmos claros y terapias rápidas y seguras para contrarrestar el compromiso neurológico severo del paciente. Esto se debe a que existen pocos estudios realizados en ACV pediátrico que describan el manejo médico adecuado o las intervenciones necesarias en esta patología, por lo cual no se tienen pautas claras para contrarrestar el evento agudo. Por lo tanto, se tienen intervenciones como trombectomía y la hemicraniectomia decompresiva, lo que lleva al paciente pediátrico a un riesgo mayor, pero tienen respuesta favorable en la mortalidad, con una recuperación favorable. Presentamos el caso clínico de un paciente pediátrico con ACV de territorio de arteria cerebral media derecha, su diagnóstico y tratamiento definitivo, con revisión de la literatura.

Headache as emergency

The symptom "headache" is an interdisciplinary clinical picture with multiple differential diagnoses. On the one hand, headache can be a symptom of harmless diseases, on the other hand, it can be an expression of a serious condition with a high-risk potential for the patient. Radiological cross-sectional imaging, laboratory investigations or a diagnostic lumbar puncture are absent in the prehospital setting. Attention must be paid prehospital to a focused history and physical as well as neurological examination to identify red flags. Recognition of potentially dangerous causes is also essential for mission tactical reasons (target hospital). A reliable distinction is not always possible prehospital, so that in case of doubt, a presentation to the hospital should be made. Therapeutically, the focus is on treatment according to the ABCDE scheme and symptomatic therapy.

Osteopoikilosis - associated with dwarfism and presenting as painful joint effusion

Osteopoikilosis is usually asymptomatic with only 15-20% patient having pain or joint effusion. Sclerotic dysplasia has multiple differential diagnosis including benign and malignant etiology. Characteristic features of symmetric, round to oval sclerotic lesions in multiple joints with axial skeleton sparing, no cortical erosion, normal clinical and blood investigations help differentiate osteopikilosis from critical malignant sclerotic pathology.

Diagnostic difficulties in bipolar disorder type II

IntroductionBipolar disorder is one of the top 10 medical causes of disability according to the WHO and despite this, its diagnosis can be delayed up to 10 years after the appearance of the first symptoms of the disease. A major reason for the difficult diagnosis is the challenge of differentiating bipolar disorder type II from unipolar depression and borderline personality disorder, especially in those patients with no clear history of hypomania.ObjectivesTo present a case report of a bipolar disorder undiagnosed for years to remark the importance of recognizing premorbid symptoms of the disease in order to implement an early intervention that potentially improves the prognosis of patients.MethodsWe compiled the patient’s complete medical history and we carried out a non-systematic review of literature containing the key-words “bipolar disorder type II” and “diagnosis”.ResultsWe present the case of a 48-year-old woman going through a depressive episode, multiple suicide attempts and more than 10 admissions in the Acute Inpatient Psychiatric Unit. For 3 years, the evolution was torpid with a significant multidomain cognitive impairment in a previously functional patient. Different antidepressant treatments were tested, however they were not tolerated due to adverse effects such as anxiety, insomnia and nervousness. After considering multiple differential diagnoses, bipolar disorder type II was finally diagnosed. A hypomanic episode that took place after 3 sessions of electroconvulsive therapy during an admission for depression, allowed to guide the diagnosis and after the introduction of Lithium and Quetiapine as treatment, the patient experienced a complete remission of the symptoms.Conclusions1.It is important to consider the differential diagnosis of bipolar disorder type II due to its impact on the patient´s life.2.An early diagnosis improves the course and prognosis of the disease.3.Patients resistant or intolerant to antidepressant treatment could have undiagnosed bipolar disorder.Disclosure of InterestNone Declared

Migraine-related white matter lesions: A common cause of misdiagnosis in the multiple sclerosis differential diagnosis

Migraine-related white matter lesions: A common cause of misdiagnosis in the multiple sclerosis differential diagnosis

Adherence to treatment as a prognostic factor for histoplasmosis in a patient with AIDS

Diseases caused by human herpesvirus 8 (HHV-8) can affect immunosuppressed patients, particularly those co-infected with the human immunodeficiency virus (HIV). Castleman disease is one such condition that is rare and challenging to diagnose, given its numerous nonspecific symptoms and multiple differential diagnoses. This study reports a case of a patient living with HIV who was diagnosed with multicentric Castleman disease, wherein the diagnosis was facilitated by the concomitant presence of Kaposi sarcoma in the gastrointestinal tract, both of which are directly related to HHV-8 infection.

Pregnancy associated atypical hemolytic uremic syndrome presenting with preeclampsia with HELLP syndrome and following treatment with Eculizumab

Abstract Objectives Pregnancy associated atypical hemolytic uremic syndrome (p-aHUS) is a rare condition of thrombotic microangiopathy (TMA) which causes an increase of fetal and maternal morbidity and mortality. It presents typically with a triad of microangiopathic hemolytic anemia (MAHA), thrombocytopenia and acute progressive renal failure. Differential diagnoses of HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome, preeclampsia, thrombotic thrombocytopenic purpura (TTP), and disseminated intravascular coagulation (DIC) syndrome must be considered. In the following case report, presented is a 32-year-old, 38 weeks pregnant Caucasian woman admitted to Eberswalde Hospital with signs of preeclampsia and HELLP Syndrome. Caesarean Section was performed due to HELLP syndrome and fetal distress. Acute renal failure occurs shortly after a successful delivery. After a diagnosis of p-aHUS is established, the patient was given Eculizumab, which yielded significant improvements. Case presentation A 32-year-old, 38 week pregnant Caucasian woman was admitted to Eberswalde Hospital with upper right abdominal pain. After a laboratory examination, a diagnosis of HELLP syndrome was established and a Caesarean Section was performed. The follow-up examination revealed deterioration of clinical signs with the patient experiencing dyspnea, oliguria, and oedema, as well as aggravation of laboratory values, ranging from severe thrombocytopenia, hemolytic anemia, liver injury, and acute kidney injury. After excluding other possible causes of TMA, a diagnosis of p-aHUS was established and a treatment with Eculizumab was administered. Clinical and laboratory signs of hemolysis and kidney functions were found to improve gradually after two administrations of Eculizumab. The patient was discharged after 20 days of hospitalization with significantly improved condition and hematological values. Conclusions A successful treatment of p-aHUS requires a comprehensive assessment and a prompt diagnosis, which can be confounded by multiple similar differential diagnoses. Treatment with Eculizumab was found to significantly improve the outcome of the patient, but more studies are required to decide on a standardized regiment for p-aHUS.

Pulmonary edema in a pediatric cancer patient after anesthetic induction.

Negative pressure pulmonary edema (NPPE) in the context of anesthesia is a rare condition, although pediatric patients are at higher risk. This case stands out for the severe respiratory clinic that quickly developed in a child with a cancer history whose radiological and clinical presentation suggested multiple differential diagnoses, including tumor recurrence with metastasis or pulmonary tuberculosis. NPPE is a well-described, but a probably underrecognized clinical syndrome, that occurs after intense inspiratory effort against an obstructed airway. In clinical practice, when unexplained pulmonary edema takes place, NPPE should be considered in the differential diagnosis. NPPE usually has a favorable prognosis but pediatricians, radiologists, and anesthesiologists should be aware of this complication.

Bedside Lung Ultrasound as an Independent Tool to Diagnose Pneumonia in Comparison to Chest X-ray: An Observational Prospective Study from Intensive Care Units.

BackgroundDiagnosing pneumonia is challenging because of multiple differential diagnosis. Bedside lung ultrasound (BLUS) is a safe, portable, rapid and inexpensive new modality to diagnose pneumonia. This study was aimed to evaluate the sensitivity of BLUS vs chest X-ray (CXR) to diagnose community-acquired pneumonia (CAP) using computed tomography (CT) scans as the gold standard.Patients and methodsAn observational cross-sectional study was conducted in selected intensive care units (ICUs). Eligible 85 adult patients with symptoms suggestive of pneumonia as per 2007 Infectious Disease Society of America (IDSA), American Thoracic Society (ATS) criteria, and 2D echocardiography were enrolled consecutively by using convenient sampling technique. Real-time reverse transcription-polymerase chain reaction (RT-PCR) assay for SARS-associated coronavirus was sent with in 1 hour followed by BLUS and CXR within 24 hours of ICU admission. The final confirmation of CAP was done by a thoracic CT scan.ResultsBedside lung ultrasound vs CXR could detect 74 vs 58 cases out of 84 confirmed cases. Sensitivity and specificity of BLUS vs CXR was 88.1% vs 67.8% and 100% vs 0%, respectively. Moreover, LR+ and LR− for BLUS was found to be 0 and 0.12 in comparison to 0.68 and 0 for CXR. The area under receiver operator characteristics (ROC) curve for BLUS vs CXR was 0.94 (95% CI 0.0–1.0) with p = 0.13 and 0.66 (95% CI 0.12–1.0) with p = 0.58. There was a significant agreement between diagnostic accuracy of BLUS and CT scan [kappa value (κ) = 0.14, p = 0.009], whereas CXR could not establish its diagnostic efficiency (κ = −0.023, p = 0.493). Sonographic features of pneumonia were B-lines, shred, and hepatization signs.ConclusionIt is observed that BLUS showed higher sensitivity, specificity, and diagnostic accuracy as compared to CXR to diagnose pneumonia.How to cite this articleDhawan J, Singh G. Bedside Lung Ultrasound as an Independent Tool to Diagnose Pneumonia in Comparison to Chest X-ray: An Observational Prospective Study from Intensive Care Units. Indian J Crit Care Med 2022;26(8):920–929.

Evaluation of the Perioperative and Postoperative Course of Surgery for Pineal Germinoma in the SIOP CNS GCT 96 Trial.

Simple SummaryThere are many studies that discuss pineal tumors (not specifically germinoma). Some advocate for biopsy over resection due to the fact that germinoma is radio- and chemosensitive; others advocate for primary resection due to multiple differential diagnoses that require resection in the pineal region, such as pineocytoma, teratoma, meningioma, epidermoid, etc. However, with respect to solitary pineal germinoma, there is still no study that analyzes and compares both surgical options regarding peri- and postoperative courses and complications. We evaluated the perioperative course and postoperative complications of patients with isolated pineal germinoma who underwent a primary biopsy or resection, treated according to the European SIOP CNS GCT 96 trial. The key finding of our study was that postoperative complications, including hydrocephalus, Parinaud syndrome, double vision, etc., were significantly higher in patients who underwent primary resection (p < 0.008).Background: CNS germinoma, being marker-negative, are mainly diagnosed by histological examination. These tumors predominantly appear in the suprasellar and/or pineal region. In contrast to the suprasellar region, where biopsy is the standard procedure in case of a suspected germ-cell tumor to avoid mutilation to the endocrine structures, pineal tumors are more accessible to primary resection. We evaluated the perioperative course of patients with pineal germinoma who were diagnosed by primary biopsy or resection in the SIOP CNS GCT 96 trial. Methods: Overall, 235 patients had germinoma, with pineal localization in 113. The relationship between initial symptoms, tumor size, and postoperative complications was analyzed. Results: Of 111 evaluable patients, initial symptoms were headache (n = 98), hydrocephalus (n = 93), double vision (n = 62), Parinaud syndrome (n = 57), and papilledema (n = 44). There was no significant relationship between tumor size and primary symptoms. A total of 57 patients underwent primary resection and 54 underwent biopsy. Postoperative complications were reported in 43.2% of patients after resection and in 11.4% after biopsy (p < 0.008). Biopsy was significantly more commonly performed on larger tumors (p= 0.002). Conclusions: These results support the practice of biopsy over resection for histological confirmation of pineal germinoma.

Iatrogenic calcinosis cutis in 9-month-old baby boy: a case report

BackgroundCalcinosis cutis is a rare condition, characterized by an accumulation of calcium salts in the skin and subcutaneous tissue. There are several types of this condition, including dystrophic, metastatic, idiopathic, calciphylaxis, and iatrogenic calcinosis cutis. The type related to our case is iatrogenic calcinosis cutis, and one its possible causes is calcium intravenous infusion. Physicians should be aware of this condition when giving calcium infusion.Case presentationHere we report the case of a 9-month-old Arabic - Saudi baby boy, who presented with abnormal movement for 1 day. Upon further investigation, his abnormal movement was found to be a manifestation of hypocalcemia and vitamin D deficiency. He was treated with intravenous calcium gluconate. Later, he had a treatment-related complication of intravenous calcium at the site of venipuncture causing swelling, which was initially soft but progressed to hard, over the left hand. Eventually, he was diagnosed with a case of iatrogenic calcinosis cutis due to intravenous calcium treatment.ConclusionThere are multiple differential diagnoses of calcinosis cutis, as it resembles many other conditions. Careful history-taking, physical examination, and other investigations, such as radiological investigations, will aid in reaching a more accurate diagnosis and, thus, early treatment and intervention. Frequently checking the intravenous line and diluting the intravenous calcium may help reduce the occurrence of iatrogenic calcinosis cutis.