Ochronosis diagnosed after knee arthroscopy

Abstract

INTRODUCTIONOchronosis is a rare disorder which is defined as the deposition of metabolites of oxidation and polymerization of homogentisic acid, which have high affinity to collogen, in the connective tissues. It is a clinical condition characterized with ochronotic pigmentation of tissues, degenerative arthropathy of especially large joints and black discoloration of urine. In this paper we present a case of ochronosis diagnosed with biopsy and additional tests when a black discoloration of menisci and joint cartilage were detected during arthroscopic intervention for a degenerative meniscus tear.PRESENTATION OF CASEA forty two year-old male patient was operated for lateral meniscus tear of his right knee. The arthroscopic examination of right knee revealed black colored synovial hypertrophy and torn lateral meniscus. Partial meniscectomy was performed. The diagnosis of ochronosis was made after histopathologic examination.DISCUSSIONOchronotic pigment can accumulate in hyaline cartilage, tendon, skin, teeth, nail, sclera, tympanic membrane, heart valves, renal tubular cells, duramater, pancreas and walls of large arteries. In ochronosis the most frequently involved joints are knee and hip. In ochronotic arthropathy, articular cartilage become more sensitive to mechanical stresses. Our patient had meniscal tear, cartilage damage and black discoloration of synovial tissues and meniscus.CONCLUSIONArthroscopy may be helpful in diagnosis of ochronotic arthropathy.

Orthopedic Manifestations of Ochronosis: Pathophysiology, Presentation, Diagnosis, and Management

“…11 Arthroscopy is an effective tool aiding diagnosis of ochronosis. 17 Doganavsargil et al 10 report a spectrum of characteristic degenerative changes to affected joints, including fibrillation, eburnation, subchondral sclerosis, osteophytes, loose bodies, synovial inflammatory reaction, disc degeneration, and tendon rupture. Histologically, the appearance of yellow-brown ochronotic pigment within the affected tissues with hematoxylin-eosin staining and the presence of pigmented giant cells within a thickened, inflamed synovium are characteristic features.…”

“…Histologically, the appearance of yellow-brown ochronotic pigment within the affected tissues with hematoxylin-eosin staining and the presence of pigmented giant cells within a thickened, inflamed synovium are characteristic features. 11,14 MANAGEMENT Kara et al 17 summarize current treatment options as including the administration of nonsteroidal antiinflammatory drugs and preparations containing glucosamine and chondroitin sulfate, intra-articular injection of hyaluronic acid and steroids, arthroscopic debridement of the affected joint, and arthroplasty. 17 Currently, there is no proven therapy or prophylactic treatment for alkaptonuric patients.…”

Misdiagnosis of alkaptonuria in an elderly patient

“…Kara et al 20 summarized the current treatment options including NSAIDs and preparations containing glucosamine and chondroitin sulfate, intra-articular injections of hyaluronic acid and steroids, arthroscopic debridement of the affected joint and arthroplasty 2,20 . Currently there is no established therapy or prophylactic treatment of alkaptonuria.…”

Calcaneal Avulsion of an Ochronotic Achilles Tendon: A Case Report

“…With advances in modern molecular identifying techniques, the early diagnosis of ochronosis can initiate early treatment before the destruction of tissues occurs (5,10,11). Dietary reduction of phenylalanine and tyrosine with administration of vitamin C of 1 g/day, vitamin E, nitisinone, N-acetyl cysteine, chondroitin, and glycosaminoglycan has been recommended (12)(13)(14)(15). Nitisinone (Orfadin Ò ; Sobi, Stockholm, Sweden) inhibits 4-OH phenylpyruvate dioxygenase enzyme and prevents the synthesis of homogentisic acid (3,8,14,16,17).…”