ABSTRACT
Both gout and pseudogout are crystal-induced arthropathies. Here, we report a case of acute calcium pyrophosphate dihydrate (CPPD) arthritis associated with type 1 myocardial infarction (MI). An 83-year-old female presented to our emergency department with generalized weakness and bilateral lower extremity edema. Her left foot was noted to be more inflamed compared to the right, with cardinal signs of pain, swelling, erythema, and warmth. A presumptive diagnosis of cellulitis was made, and antibiotics were initiated. Further investigations revealed elevated troponins with new-onset bundle branch block, ST, and T-wave changes on electrocardiogram, indicating a type 1 MI. After a review of the patient's history, imaging of the extremity, elevated inflammatory markers, and the typical distribution and pattern of inflammation, the diagnosis was changed to pseudogout. Steroids and colchicine were initiated, providing instant relief. This case highlights a possible association between cardiovascular disease and pseudogout, emphasizing the need for further studies regarding this relationship. Despite being rare, physicians should be made aware of this relationship, especially in patients with a history of CPPD arthritis presenting with type 1 MI.
ABSTRACT
Both pseudogout and cellulitis are diseases that may mimic one another in clinical practice. We discuss two cases of acute calcium pyrophosphate dihydrate (CPPD) arthritis mistaken for cellulitis in the emergency department. Both patients experienced significant improvement after management was changed to treat CPPD. These cases highlight how it is essential for physicians to consider CPPD as a differential diagnosis for a patient that is presenting with signs of inflammation in any joint.
ABSTRACT
INTRODUCTION: The most common pediatric fractures involve the upper extremity. But there is limited study on racial disparity in diagnostic radiography for pediatric fractures. The literature has described the diagnostic accuracy of alternative diagnostic modalities with promising evidence of its ability to mitigate health inequity in primary care. Our objective was to understand if racial disparity exists in radiography for pediatric fractures. METHODS: In this four-year retrospective cohort study, we analyzed rates of radiographic imaging and abnormal radiograph detection in 4280 pediatric patients (ages 3-18 years) who presented with chief complaints of arm or wrist pain and trauma-related International Classification of Diseases 10th Revision (ICD-10) codes. We compared White children to all other races and stratified by emergency departments (ED) vs all other primary care ambulatory service lines. Results: Non-White patients had lower imaging rate differences and lower odds receiving imaging in both ambulatory settings (0.65915, P = 0.0162; -5.4%, P = 0.0143) and in EDs (0.7732, P = 0.0369; -4.7%, P = 0.0368). Additionally, non-Whites in the ED had lower rates and lower odds of abnormal radiographs (-7.3%, P = 0.0084; 0.6794, P = 0.0089). Conclusion: Non-White patients seen in emergency and ambulatory settings had lower imaging rates for traumatic arm and wrist pain compared to White patients, indicating a healthcare disparity in pediatric imaging. Higher-level studies investigating the effect of social determinants of health, more detailed patient data, and provider bias on facture care equity are needed to understand underlying reasons for observed differences.
