Patient: Female, 34
Final Diagnosis: Basic calcium phosphate arthropathy
Symptoms: —
Medication: —
Clinical Procedure: —
Specialty: Rheumatology
Objective:
Rare co-existance of disease or pathology
Background:
Increased serum levels of basic calcium phosphate (BCP) and calcium pyrophosphate (CPP) are found in patients on dialysis, following trauma, and are associated with connective tissue diseases (CTDs), including dermatomyositis, scleroderma, and systemic lupus erythematosus (SLE). The shoulder is the joint most commonly associated with BCP crystal periarthritis. A report is presented of a case of BCP crystal periarthritis involving the distal interphalangeal (DIP) joints in a patient with SLE.
Case Report:
A 34-year-old woman with SLE presented with destructive arthritis of the DIP joints that developed during a two-year period, despite immunosuppressive therapy. Aspiration of synovial fluid from a DIP joint showed a lack of inflammatory cells, but the fluid was positive for the presence of crystals on alizarin red S histochemical staining.
Conclusions:
A case of BCP crystal periarthritis is reported in a patient with SLE with chronic joint symptoms that were unresponsive to immunosuppressive therapy. This case has shown that chronic joint symptoms that are unresponsive to immunosuppressive therapy may be due to causes other than connective tissue disease (CTD) and that imaging studies and diagnostic workup that includes synovial fluid examination may support the diagnosis of BCP crystal periarthritis.
Ankylosing spondylitis (AS) is a rheumatological disorder of the spine, and like many other rheumatological diseases, it can manifest as a systemic inflammation. We present a rare case of cardiac manifestations of AS in a 25-year-old man with recurrent chest pain and pericardial effusions. He initially presented with pleuritic chest pain, was diagnosed with cardiac tamponade and required emergent pericardiocentesis. The patient returned again with chest pain and was found to have reaccumulation of pericardial effusion. The cardiac symptoms were finally resolved when he was diagnosed and treated for AS.
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