JAMA Clinical Challenge Section Editor: Huan J. Chang, MD, Contributing Editor. We encourage authors to submit papers for consideration as a JAMA Clinical Challenge. Please contact Dr Chang at email@example.com
Author Affiliations: Department of Internal Medicine (Dr Patel) and Division of Cardiovascular Diseases (Dr Miller), Mayo Clinic, Rochester, Minnesota; and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Patel).
A 46-year-old man receiving chronic hemodialysis for polycystic kidney disease is admitted to the hospital with new-onset dyspnea and altered sensorium. He is noted to have “milky” secretions draining from a spontaneous eruption on his left thigh (Figure 1A). His thigh is swollen; radiographs show bulky, extra-articular calcifications (Figure 1B). A 3.4 × 2.3-cm mass involving the posterior mitral leaflet associated with moderate regurgitation is found with transesophageal echocardiography.
Patel SM, Miller TD. Diffuse Calcification and a Draining Wound. JAMA. 2013;309(2):181–182. doi:10.1001/jama.2012.91090