Rehabilitation Complications in An International Case of Dermatomyositis with Calcinosis Universalis

Dermatomyositis (DM) is a rare and intricate autoimmune disorder characterized by symmetric proximal muscle weakness and a spectrum of associated cutaneous manifestations. Approximately 20-25% of patients have the anti-Nuclear Matrix Protein 2 (NXP2) gene that codes for the anti-NXP2 autoantibody, which can create a nearly linear relationship between the onset of DM and calcinosis. A 21-year-old female patient from the Caribbean with aggressive dermatomyositis (NXP-2 antibody positive) was brought to a tertiary care hospital for impending respiratory failure and was subsequently admitted to an acute Inpatient Rehabilitation Facility (IRF), where her condition was complicated by calcinosis universalis. The patient was treated with calcium channel blockers, sodium thiosulfate injections, shockwave lithotripsy, and aggressive physical therapy to address her calcinosis-related pain and functional restriction. A multidisciplinary rehabilitation approach with various interventions was implemented, yielding improvement in functional results. The international component of this case added complexity, as it involved challenges related to geographic distance, care communication, and the availability of specialized care. This case provided a unique opportunity to manage the progression of a rare, complex disease.