An 81-year-old Portuguese woman, independently mobile, with antecedents of restrictive pulmonary disease and multinodular goiter, presented to the emergency department with lumbar and left hip pain and an inability to walk or bear weight after a low-energy fall. On examination, paravertebral lumbar discomfort and left groin pain with decreased passive and active ranges of motion were noted. A hip radiograph (Fig. 1) was made, revealing an acute left-sided femoral neck fracture. Also, a lumbar radiograph (Fig. 2) was made, revealing chronic osteoporotic vertebral fractures. These fractures were assessed by computed tomographic (CT) scan to determine displacement and comminution (Fig. 3). Incidentally, hundreds of oblong calcific specks were detected in a “rice-grain calcification” appearance (Figs. 1, 2, and 3).
The patient was evaluated by an infectious disease consultant. A laboratory testing was requested, including white blood cell count, liver function, and inflammatory markers. The results did not suggest active infection; there was only a mild elevation of C-reactive protein, compatible with the post-traumatic period.
In spite of the calcifications, there was no contraindication for osteosynthesis or arthroplasty, so the patient underwent a total hip arthroplasty with cemented components (Fig. 4). A sample of muscle was obtained for histological analysis (Fig. 5) and showed fragments of skeletal muscle and adipose tissue with a mononucleated inflammatory infiltrate and multinucleated giant cells, as well as muscle cells with reactive features, suggestive of a chronic inflammatory muscular disease.
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