Calcium pyrophosphate dihydrate deposition disease in the temporomandibular joint: diagnosis and treatment / 대한악안면성형재건외과학회지

BACKGROUND: Calcium pyrophosphate dihydrate deposition disease (CPDD) is a rare disease in the temporomandibular joint (TMJ) space. It forms a calcified crystal mass and induces a limitation of joint movement. CASE PRESENTATION: The calcified mass in our case was occupied in the left TMJ area and extended to the infratemporal and middle cranial fossa. For a complete excision of this mass, we performed a vertical ramus osteotomy and resected the mass around the mandibular condyle. The calcified mass in the infratemporal fossa was carefully excised, and the segmented mandible was anatomically repositioned. Scanning electronic microscopy (SEM)/energy-dispersive X-ray spectroscopy (EDS) microanalysis was performed to evaluate the calcified mass. The result of SEM/EDS showed that the crystal mass was completely composed of calcium pyrophosphate dihydrate. This result strongly suggested that the calcified mass was CPDD in the TMJ area. CONCLUSIONS: CPDD in the TMJ is a rare disease and is difficult to differentially diagnose from other neoplasms. A histological examination and quantitative microanalysis are required to confirm the diagnosis. In our patient, CPDD in the TMJ was successfully removed via the extracorporeal approach. SEM/EDS microanalysis was used for the differential diagnosis.

A Case of Acute Calcium Pyrophosphate Crystal Arthritis in the Lumbar Facet Joint

Calcium pyrophosphate dihydrate deposition disease most commonly presents with acute arthritis of the peripheral joints. Infrequently, a mass effect of this disease can cause axial symptoms, such as spinal stenosis, radiculopathy, or myelopathy. Herein, we report on the first Korean case of acute arthritis in the lumbar facet joint due to calcium pyrophosphate dihydrate crystal deposition disease. A 73-year-old female presented with acute fever, severe lumbago, and knee arthralgia, 11 days after partial parathyroidectomy. Plain radiographs showed multiple chondrocalcinosis, while a bone scan, computed tomography, and magnetic resonance imaging showed right L5-S1 facet arthritis. In synovial fluid from the facet and knee joints, positively birefringent calcium pyrophosphate dihydrate crystals were observed under polarized light microscopy. Under the diagnosis of acute calcium pyrophosphate dihydrate crystal arthritis (formerly known as 'pseudogout') in the facet joint, an intra-articular triamcinolone injection was administered, which resulted in dramatic improvement of the symptoms within 24 hours.

Ultrasonographic Assessment in Crystal-induced Arthritis / 대한내과학회지

The latest recommendations for the diagnosis and management of crystal-induced arthritis, such as gout and calcium pyrophosphate dihydrate (CPPD) deposition disease, recognize the diagnostic potential of musculoskeletal ultrasonography (MSUS). MSUS allows rapid, highly sensitive, non-invasive detection of microcrystal aggregates in multiple anatomic areas, and can be used as a safe, reliable guide for aspiration of articular and periarticular specimens suitable for microscopic analysis. MSUS can also be used to monitor disease after treatment. Ultrasonographic differentiation between gout and CPPD deposition disease is based on the characteristics of crystal aggregates and their preferential localization in different anatomical areas. This rapid assessment may profoundly affect the clinical process, avoiding expensive, time-consuming diagnostic procedures. This article reviews the current status of and recent advances in MSUS imaging in crystal-induced arthritis.

A Case of Calcium Pyrophosphate Dihydrate Deposition Disease Associated with Primary Hyperparathyroidism

Calcium pyrophosphate dihydrate (CPPD) deposition disease is a heterogeneous group of diseases with CPPD crystal deposition. Aging is the most common risk factor for CPPD deposition, followed by osteoarthritis and previous injury. Occasionally, CPPD depositions are associated with familial predisposition and metabolic diseases, including hemochromatosis, primary hyperparathyroidism, hypophosphatasia, and hypomagnesemia. CPPD deposition diseases associated with primary hyperparathyroidism in Koreans have rarely been reported. Thus, we report a case of a relatively young female patient with CPPD deposition disease associated with primary hyperparathyroidism, which was diagnosed through a polarized microscopic examination of the synovial fluid and a subtotal parathyroidectomy.

A Case of CPPD Crystal Deposition Disease in a Patient with Rheumatoid Arthritis and Systemic Sclerosis / 대한류마티스학회지

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structures. CPPD crystal deposition disease has various clinical manifestation patterns ranging from an absence of symptoms to a severely destructive arthropathy. CPPD crystal deposition disease very rare with rheumatoid arthritis or systemic sclerosis. We report a case of CPPD crystal deposition disease combined in a patient with rheumatoid arthritis and systemic sclerosis.

Idiopathic Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease in a Young Female Patient : A Case Report

PURPOSE: Calcium pyrophosphate dihydrate crystal deposition disease(CPPD) is a disease of the elderly and extremely rare in young individuals. If young people develop CPPD crystal deposition disease, it may be associated with metabolic diseases, such as hemochromatosis, hyperparathyroidism, hypophosphatasia, hypomagnesemia, Wilson's disease, hypothyroidism, and gout. MATERIALS AND METHODS: Therefore, in young-onset CPPD crystal deposition disease, an investigation of any predisposing metabolic conditions is warranted. CONCLUSION: We report a case of a young female patient who presented with idiopathic CPPD crystal deposition disease at 25 years of age.

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease in the Cervical Ligamentum Flavum: A Case Report / 대한척추외과학회지

Calcium pyrophosphate dihydrate deposition disease (CPPD) is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structures. The cervical ligamentum flavum is a rare location of CPPD deposition. A 65-year-old woman was admitted with complaints of neck pain and a tingling sensation and numbness below the xiphoid process for 2 months. Magnetic resonance (MR) imaging and computed tomography (CT) revealed compression of the spinal cord due to a nodular calcified mass in or attached to the ligamentum flavum at the C4-5, C5-6, or C6-7 level. The patient underwent a laminectomy at C4-5, C5-6, and C6-7, and resectioning of calcified extradural nodules that impinged on the cervical cord. The operation resulted in a resolution of neck pain and hypoesthesia, except in the feet. Histopathological examination of the excised specimen revealed rectangular CPPD crystals. Here, we report a case of compressive cervical spine due to CPPD deposition disease of the cervical spine and describe the literature relevant to CPPD deposition disease of the cervical spine.

A case of calcium pyrophosphate dihydrate deposition disease causing compressive cervical myelopathy / 대한내과학회지

Calcium pyrophosphate dihydrate (CPPD) deposition disease is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structure. Spinal involvement in CPPD deposition disease is rare. We reported a rare case of CPPD deposition disease that caused compressive cervical myelopathy. A 57-year-old woman was admitted to the hospital with 1 week history of progressive paresis of the right upper and lower extremities. Computed tomography showed the round and nodular calcified ligamentum flavum. Magnetic resonance imaging showed a low intensity epidural mass pressing and distorting the cervical cord at C-4 and 5 levels on both T1 and T2- weighted images. Radiographic findings were consistent with calcification of the ligamentum flavum in the C-4 and 5 levels causing cord compression. The lesion was eventually removed by hemilaminectomy. The mass was composed of a very hard crystal like calcified deposition in the ligamentum flavum. The histopathological evaluation of the exicised ligamentum flavum revealed the characteristic crystals of CPPD.

Idiopathic Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease in a Young Male Patient: A Case Report

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is a disease of the elderly and extremely rare in young individuals. If young people develop CPPD crystal deposition disease, it may be associated with metabolic diseases such as hemochromatosis, hyperparathyroidism, hypophosphatasia, hypomagnesemia, Wilson's disease, hypothyroidism, gout, acromegaly, and X-linked hypophosphatemic rickets. Therefore, in young-onset polyarticular CPPD crystal deposition disease, investigation for predisposing metabolic conditions is warranted. We report a case of a young male patient with idiopathic CPPD crystal deposition disease, who did not have any evidences of metabolic diseases after thorough evaluations. As far as we know, this is the first report of a young male patient presented with idiopathic CPPD crystal deposition disease.

A Case of Calcium Pyrophosphate Dihydrate Crystal Deposition Disease Presenting as an Acute Polyarthritis

We report a case of calcium pyrophosphate dihydrate crystal deposition disease (CPDD) presenting as an acute polyarthritis. A 66-yr-old woman was admitted with a 5-day history of fever and multiple joint pain including wrists, elbows, shoul-ders, knees, and ankles developed 5 days before admission. Her plain radiographs of wrists, elbows, shoulders, knees, and ankles showed chondrocalcinosis. The pubic symphysis, lumbar intervertebral discs, and both hip joints, which were asymptomatic, also had calcium deposits. The compensated polarized microscopic examination of the joint fluid, aspirated from the right knee revealed intracellular and extracellular weakly positive birefringent crystals, confirming the CPDD. This case showed that CPDD may manifest as an acute polyarthritis mimicking acute onset rheumatoid arthritis.