Pseudogout and Calcium Pyrophosphate Disease
History of present illness: A 53-year-old male presented with worsening right knee pain and swelling over the past 48 hours. He denied recent trauma to the knee, history of IV drug use, and recent illness. He had no history of diabetes, immunodeficiency, chronic steroids, rheumatologic disease, or...
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2017-01-01
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| Series: | Journal of Education and Teaching in Emergency Medicine |
| Subjects: | |
| Online Access: | http://jetem.org/pseudogout/ |
| _version_ | 1819264492157009920 |
|---|---|
| author | Andrew Williamson |
| author_facet | Andrew Williamson |
| author_sort | Andrew Williamson |
| collection | DOAJ |
| description | History of present illness:
A 53-year-old male presented with worsening right knee pain and swelling over the past 48 hours. He denied recent trauma to the knee, history of IV drug use, and recent illness. He had no history of diabetes, immunodeficiency, chronic steroids, rheumatologic disease, or knee replacement. He described the pain as sharp, non-radiating, and worse with movement. He was unable to walk due to pain.
Significant findings:
Radiographs of the knee showed multiple radio-dense lines paralleling the articular surface (see red arrows) consistent with calcium pyrophosphate crystal deposition within the joint often seen in calcium pyrophosphate disease (CPPD) also known as pseudogout.
Discussion:
Patients commonly present to the emergency department with non-traumatic joint pain. Arthrocentesis is an important diagnostic tool to evaluate for septic arthritis, gout, or pseudogout. Arthrocentesis can demonstrate crystals or abnormal cell count, gram stain, and culture.[1] In the evaluation of joint pain, plain films are usually obtained to evaluate for fracture, dislocation, effusion, or secondary signs of infection. In this case the classic x-ray supported the diagnosis of CPPD.2 The patient was found to have positively birefringent rhomboid shaped crystals consistent with pseudogout on arthrocentesis. Gram stain and culture were both negative. The patient was discharged with NSAIDs and had significant improvement in symptoms upon follow up with primary care physician in 3 days. |
| first_indexed | 2024-12-23T20:30:20Z |
| format | Article |
| id | doaj.art-53fea5914abe46c997d71b80d7600dc5 |
| institution | Directory Open Access Journal |
| issn | 2474-1949 2474-1949 |
| language | English |
| last_indexed | 2024-12-23T20:30:20Z |
| publishDate | 2017-01-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Journal of Education and Teaching in Emergency Medicine |
| spelling | doaj.art-53fea5914abe46c997d71b80d7600dc52022-12-21T17:32:15ZengeScholarship Publishing, University of CaliforniaJournal of Education and Teaching in Emergency Medicine2474-19492474-19492017-01-0121V8V9doi:10.21980/J8QG66Pseudogout and Calcium Pyrophosphate DiseaseAndrew Williamson0Kaiser Permanente—San DiegoHistory of present illness: A 53-year-old male presented with worsening right knee pain and swelling over the past 48 hours. He denied recent trauma to the knee, history of IV drug use, and recent illness. He had no history of diabetes, immunodeficiency, chronic steroids, rheumatologic disease, or knee replacement. He described the pain as sharp, non-radiating, and worse with movement. He was unable to walk due to pain. Significant findings: Radiographs of the knee showed multiple radio-dense lines paralleling the articular surface (see red arrows) consistent with calcium pyrophosphate crystal deposition within the joint often seen in calcium pyrophosphate disease (CPPD) also known as pseudogout. Discussion: Patients commonly present to the emergency department with non-traumatic joint pain. Arthrocentesis is an important diagnostic tool to evaluate for septic arthritis, gout, or pseudogout. Arthrocentesis can demonstrate crystals or abnormal cell count, gram stain, and culture.[1] In the evaluation of joint pain, plain films are usually obtained to evaluate for fracture, dislocation, effusion, or secondary signs of infection. In this case the classic x-ray supported the diagnosis of CPPD.2 The patient was found to have positively birefringent rhomboid shaped crystals consistent with pseudogout on arthrocentesis. Gram stain and culture were both negative. The patient was discharged with NSAIDs and had significant improvement in symptoms upon follow up with primary care physician in 3 days.http://jetem.org/pseudogout/Pseudogoutcalcium pyrophosphate diseasenon-traumatic joint painorthopedicspositively birefringent rhomboid crystalsarthrocentesis |
| spellingShingle | Andrew Williamson Pseudogout and Calcium Pyrophosphate Disease Journal of Education and Teaching in Emergency Medicine Pseudogout calcium pyrophosphate disease non-traumatic joint pain orthopedics positively birefringent rhomboid crystals arthrocentesis |
| title | Pseudogout and Calcium Pyrophosphate Disease |
| title_full | Pseudogout and Calcium Pyrophosphate Disease |
| title_fullStr | Pseudogout and Calcium Pyrophosphate Disease |
| title_full_unstemmed | Pseudogout and Calcium Pyrophosphate Disease |
| title_short | Pseudogout and Calcium Pyrophosphate Disease |
| title_sort | pseudogout and calcium pyrophosphate disease |
| topic | Pseudogout calcium pyrophosphate disease non-traumatic joint pain orthopedics positively birefringent rhomboid crystals arthrocentesis |
| url | http://jetem.org/pseudogout/ |
| work_keys_str_mv | AT andrewwilliamson pseudogoutandcalciumpyrophosphatedisease |