scholarly journals Calcium pyrophosphate dihydrate crystal deposition disease and MRSA septic arthritis of the atlantoaxial joint in a patient with Tourette syndrome

2019 ◽  
Vol 12 (3) ◽  
pp. e228102
Author(s):  
Edward Nicholas Northrup ◽  
Benjamin Robert Pflederer
Keyword(s):  
Neck Pain ◽  
Septic Arthritis ◽  
Tourette Syndrome ◽  
Cervical Vertebrae ◽  
Limited Range ◽  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Dihydrate ◽  
Atlantoaxial Joint ◽  
Crystal Deposition ◽  
Limited Range Of Motion

A 45-year-old male patient with Tourette syndrome presented to the emergency department with worsening neck pain and stiffness of 1-week duration. Associated symptoms included headache, hoarse voice, trismus and odynophagia. The patient was haemodynamically stable without fevers or leucocytosis. He exhibited cervical spinal and paraspinal tenderness with very limited range of motion. Erythrocyte sedimentation rate and C reactive protein were elevated, and blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Lumbar puncture was unremarkable. CT and MRI of the neck showed calcification of the longus colli, fluid and capsular distention of C1–C2 joints, enhancement of the joint capsule and retropharyngeal oedema suggestive of septic arthritis. Fluid was aspirated from C1 to C2 joint by interventional radiology and showed calcium pyrophosphate crystals and heavy MRSA colonisation, consistent with both pseudogout and septic arthritis of the cervical vertebrae. The patient was started on a 6-week course of daptomycin and showed gradual improvements in neck pain and mobility.

Calcium pyrophosphate dihydrate crystal deposition in the craniovertebral junction

2008 ◽  
Vol 8 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Albert J. Fenoy ◽  
Arnold H. Menezes ◽  
Kathleen A. Donovan ◽  
Stephen F. Kralik
Keyword(s):  
Craniovertebral Junction ◽  
Calcium Pyrophosphate ◽  
Symptom Duration ◽  
Calcium Pyrophosphate Dihydrate ◽  
Atlantoaxial Joint ◽  
Transverse Ligament ◽  
Crystal Deposition ◽  
Lower Cranial Nerve ◽  
Pyrophosphate Dihydrate

Object Calcium pyrophosphate dihydrate (CPPD) deposition is a rare cause of retroodontoid mass lesions in elderly individuals. However, this condition may be severely underdiagnosed if sufficient attention is not paid to imaging characteristics and clinical presentation. The authors sought to evaluate the decision-making process in both the diagnosis and surgical treatment of CPPD. Methods A retrospective review of University of Iowa medical records and radiographs accumulated between 1977 and 2006 was performed. The inclusion criterion was histopathological findings consistent with pseudogout at the craniovertebral junction (CVJ). Twenty-one patients with a mean age of 70.3 years and a mean symptom duration prior to presentation of 17.5 months were identified and included in this study. Results The patients presented most frequently with occipital and neck pain (85%) and numbness or paresthesias (61%). Lower cranial nerve deficits were seen in 29%. Calcification of the mass or transverse ligament was seen on computed tomography in all included patients. Gross-total resection was achieved in all patients: 19 of 21 patients underwent transoral–transpalatopharyngeal resection, with only 16 requiring concomitant dorsal occipital–cervical fusion. The mean follow-up duration was 15 months. Eighteen patients (86%) had improvement or resolution of symptoms after treatment, and 3 were lost to follow-up. Conclusions Although rare, CPPD deposition at the CVJ should be suspected on finding calcification of and around the transverse ligament on neuroimaging. Transoral–transpalatopharyngeal resection is preferred to halt the progression of neurological deterioration; dorsal fusion is not always mandatory as concomitant ligamentous calcification and atlantoaxial joint ankylosis may provide added stability.

Calcium Pyrophosphate Dihydrate Crystal Deposition in and around the Atlantoaxial Joint: Association with Type 2 Odontoid Fractures in Nine Patients

Radiology ◽  
2000 ◽  
Vol 216 (1) ◽  
pp. 213-219 ◽  
Author(s):  
Yousuke Kakitsubata ◽  
Robert D. Boutin ◽  
Daphne J. Theodorou ◽  
Roger M. Kerr ◽  
Lynne S. Steinbach ◽  
...  
Keyword(s):  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Dihydrate ◽  
Atlantoaxial Joint ◽  
Crystal Deposition ◽  
Odontoid Fractures ◽  
Pyrophosphate Dihydrate

FLEXOR TENDON RUPTURE OF THE LITTLE FINGER CAUSED BY CALCIUM PYROPHOSPHATE DIHYDRATE CRYSTAL DEPOSITION DISEASE OF THE PISOTRIQUETRUM JOINT

Hand Surgery ◽  
2013 ◽  
Vol 18 (03) ◽  
pp. 413-415 ◽  
Author(s):  
Takuma Wakasugi ◽  
Ritsuro Shirasaka ◽  
Hiroaki Kimura ◽  
Yoshiaki Wakabayashi
Keyword(s):  
Flexor Tendon ◽  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Dihydrate ◽  
Distal Stump ◽  
Crystal Deposition ◽  
Crystal Deposition Disease ◽  
Deposition Disease ◽  
Closed Rupture ◽  
Pyrophosphate Dihydrate ◽  
Little Finger

We report a case of closed rupture of the flexor tendons of the little finger caused by calcium pyrophosphate dihydrate crystal deposition disease of the pisotriquetrum joint. The patient could not flex the little finger and did not have wrist pain. Plain radiographs of the affected wrist joint showed severe arthritic changes of the pisotriquetrum joint and calcification around the joint. At operation, the pisotriquetrum joint capsule was ruptured and involved the flexor tendon of the little finger. The distal stump of the flexor tendon was transferred to the flexor tendon of the ring finger, and the pisiform was resected. Histological examination with polarized light microscopy revealed crystals showing weakly positive birefringence in the calcification.

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