Case Report of a Difficult Airway due to Calcinosis Cutis Universalis: An Anaesthesiologist Perspective

Difficult airway is defined as a situation where a trained anaesthesiologist encounters challenges in either face mask ventilation, tracheal intubation, or both, as stated by the American Society of Anaesthesiologists. A case of a difficult airway due to Calcinosis Universalis was encountered, which is a rare subtype of connective tissue disorder. In Calcinosis Cutis, calcium is diffusely deposited in the skin, subcutaneous tissue, muscles, and tendons. Calcinosis Universalis typically appears secondary to a connective tissue disorder such as juvenile dermatomyositis, systemic lupus erythematosus, Sjögren’s syndrome, and Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia (CREST) syndrome, predominantly affecting females. There is no specific treatment available for this condition. Medically, it can be managed with calcium channel blockers like diltiazem, colchicine, immunosuppressants, and painkillers to alleviate discomfort. Antibiotics may be required for infected wounds. Surgically, lesions can be removed; however, there is a higher likelihood of recurrence. Patients with Calcinosis Universalis present a challenge for anaesthesiologists due to the involvement of joints and tendons. The present case report involves a 22-year-old female with a history of juvenile dermatomyositis for the past 15 years and Calcinosis Cutis universalis for the past 11 years presented to the Anaesthesiology department for nasal bone reduction. Upon examination, it was determined that she had a difficult airway, and awake fiberoptic intubation was performed. The present case report aims to provide unique insights into a rare case, highlighting the unusual presentation of a difficult airway and the associated perioperative challenges from an anaesthesiologist’s perspective.