Elsevier

Joint Bone Spine

Volume 81, Issue 2, March 2014, Pages 180-182
Joint Bone Spine

Case report
Axial calcium pyrophosphate dihydrate deposition disease revealed by recurrent sterile spondylodiscitis and epidural abscess

https://doi.org/10.1016/j.jbspin.2013.07.007Get rights and content

Abstract

Spondylodiscitis are frequent and clinical challenge for practionners. Axial calcium pyrophosphate dihydrate deposition disease (CPDD) is well known for cervical spine involvement with the crowned dens syndrome but other localisations are probably underdiagnosed in sterile spondylodiscitis. We report a case of recurrent sterile spondylodiscitis with epidural abscess related to CPDD proved by vertebral percutaneous needle biopsy with rapid favourable course under colchicine therapy. Axial CPDD could mimic septic spondylodiscitis with epidural abscess on MRI. Sterile spondylodiscitis are probably underdiagnosed forms of microcrystalline disease. Investigations of the presence of microcrystals should be systematically undertaken with tamponed formalin fixed biopsies. If axial CPDD is suspected, colchicine therapy could be a good therapeutic test and would avoid unnecessary antibiotic treatment.

Introduction

In addition to spinal gout [1], [2], axial calcium pyrophosphate dihydrate deposition disease (CPDD) should be considered as a differential diagnosis of septic spondylodiscitis. Axial CPDD is well known for cervical spine involvement with the crowned dens syndrome [3]. We report a case of aseptic spondylodiscitis complicated by an epidural aseptic abscess, related to diffuse CPDD, with a rapid favourable course under colchicine therapy.

Section snippets

Case report

In November 2012, an 85-year-old man with a history of prostate cancer in remission was admitted for acute inflammatory lower back pain. In 2008, he had been referred for the same symptoms, and on the basis of magnetic resonance imaging (MRI) findings septic spondylodiscitis at L2-L3 was suspected. Blood cultures and two vertebral percutaneous needle biopsies failed to identify any pathogen in 2008. Histology did not disclose any polynuclear neutrophils, granuloma or atypical cells.

Discussion

The spinal involvement of CPDD is not, therefore, restricted to the crowned dens syndrome [3], [4], aseptic psoas abscess [5], pyrophosphate deposits in the yellow ligaments [4], or involvement of the zygapophysial joints [4]. Axial CPDD could mimic septic spondylodiscitis and aseptic abscess.

This rare manifestation has been reported in axial gout [1], [2], [6], [7], [8], [9]. The diagnosis of axial CPDD should be systematically considered in the case of acute inflammatory back pain occurring

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

References (9)

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