Acute Attack of Pseudogout with the Wide Lesion in Lumbar Spondylolytic Spondylolisthesis
Joint Authors
Kaneyama, Hironari
Morishita, Yuichiro
Kawano, Osamu
Yamamoto, Takuaki
Maeda, Takeshi
Source
Issue
Vol. 2020, Issue 2020 (31 Dec. 2020), pp.1-5, 5 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2020-07-29
Country of Publication
Egypt
No. of Pages
5
Main Subjects
Abstract EN
Objective.
To report a rare case of an acute attack of calcium pyrophosphate dihydrate (CPPD) deposition disease in a patient with lumbar spondylolytic spondylolisthesis, which demonstrated widespread lesion with neurological deficit.
Methods.
An 86-year-old woman presented with high fever and bilateral neurological deficit of the lower extremities.
Results.
CRP was elevated (20.9 mg/dl).
Plain radiographs and computed tomography images showed bilateral L4 spondylolytic spondylolisthesis.
Sagittal magnetic resonance (MR) images revealed effusion at the L3-4 interspinous space, and a gadolinium- (GD-) enhanced epidural mass was observed at the level of L4 vertebral body.
Axial MR images showed an intra- or epidural lesion at L2-3.
Moreover, epidural GD-enhanced masses compressed the dural sac in the shape of a cross at the L3-4 and L4-5 segments.
The patient was suspected of having pyogenic arthritis of the lumbar spine in initial diagnosis.
A total of 1.2 ml of fluid with a murky, pus-like synovial effusion was aspirated from the L3-4 interspinous space under the fluoroscopic image.
Smear speculum of synovial fluid tested negative for bacteria and fungi; however, a number of crystals were seen.
Based on the result of smear speculum, we suspected the pathology as crystal deposition disease.
Based on polarized light microscopy, which revealed monocle or triclinic intracellular crystals with a positive birefringence, the patient was diagnosed with pseudogout of the lumbar spine.
Nonsteroidal anti-inflammatory drugs (NSAIDs) were administered by intravenous drip injection for 3 days, and local and systemic inflammatory signs, as well as neurological deficits, dramatically improved.
Conclusions.
We encountered the rare case of an acute attack of pseudogout with the wide lesion in the lumbar spondylolytic spondylolisthesis.
Multiple culture of the effusion provided a definitive diagnosis, which allowed for appropriate, minimally invasive treatment for 8 weeks of NSAID administration that provided the satisfactory recovery from the symptoms.
American Psychological Association (APA)
Kaneyama, Hironari& Morishita, Yuichiro& Kawano, Osamu& Yamamoto, Takuaki& Maeda, Takeshi. 2020. Acute Attack of Pseudogout with the Wide Lesion in Lumbar Spondylolytic Spondylolisthesis. Case Reports in Orthopedics،Vol. 2020, no. 2020, pp.1-5.
https://search.emarefa.net/detail/BIM-1149907
Modern Language Association (MLA)
Kaneyama, Hironari…[et al.]. Acute Attack of Pseudogout with the Wide Lesion in Lumbar Spondylolytic Spondylolisthesis. Case Reports in Orthopedics No. 2020 (2020), pp.1-5.
https://search.emarefa.net/detail/BIM-1149907
American Medical Association (AMA)
Kaneyama, Hironari& Morishita, Yuichiro& Kawano, Osamu& Yamamoto, Takuaki& Maeda, Takeshi. Acute Attack of Pseudogout with the Wide Lesion in Lumbar Spondylolytic Spondylolisthesis. Case Reports in Orthopedics. 2020. Vol. 2020, no. 2020, pp.1-5.
https://search.emarefa.net/detail/BIM-1149907
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1149907