Case reportAxial calcium pyrophosphate dihydrate deposition disease revealed by recurrent sterile spondylodiscitis and epidural abscess
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)
- et al.
Sterile spondylodiscitis
Lancet
(2012) - et al.
Arthropathies du rhumatisme à pyrophosphate de calcium (PPCa)
Rev Rhum Monogr
(2013) - et al.
Tophaceous gout of the lumbar spine mimicking pyogenic discitis
Spine J
(2007) - et al.
Tophaceous gout of the lumbar spine mimicking infectious spondylodiscitis and epidural abscess: MR imaging findings
J Clin Neurosci
(2005)
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Pseudogout of the lumbar spine
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2022, Radiology Case ReportsCitation Excerpt :In acute spinal CPPD deposition disease, an inflammatory mass may form around the calcium crystal deposit as the inflammation spreads. Various sites where the mass may form, such as intervertebral discs, posterior vertebral bodies, and spinous processes, have been reported, although they often have a contrast enhancement and need to be differentiated from vertebral discitis, epidural abscess, and metastasis [4–6]. Acute CPPD deposition disease in the cervical spine is widely recognized as crowned dens syndrome and is often treated appropriately [5,6].
The NIMS framework: an approach to the evaluation and management of epidural abscesses
2021, Spine JournalCitation Excerpt :Open biopsy has about a 30% greater yield compared with percutaneous biopsy and should be considered in cases of diagnostic need [31]. Biopsy may also help differentiate infection from other mimicking conditions such as neuropathic spine [32], malignancy [30], and even crystalline disease [33]. Similar to the need for continuous neurologic reassessment within the NIMS framework, there should also be a continuous reevaluation of the clinical progression and infectious treatment response.
Spinal involvement with calcium pyrophosphate deposition disease in an academic rheumatology center: A series of 37 patients
2019, Seminars in Arthritis and RheumatismCitation Excerpt :Symptoms are alleviated with colchicine or NSAIDs, but septic discitis remains an important differential diagnosis because the affected patients frequently present inflammatory pain and increased acute-phase reactants [46,47]. Moreover, MRI features suggestive of an epidural [45] or psoas abscess [48] have been reported. Needle biopsy is frequently required to rule out infection.
Degenerative Disc Disease Mimicking Spondylodiscitis with Bilateral Psoas Abscesses
2018, World NeurosurgeryCitation Excerpt :Favorable clinical and imaging outcome without antibiotic therapy supported the diagnosis of inflammatory disc herniation and degenerative disc disease. Mimicks of infectious spondylodiscitis14 include microcrystaline disease such as calcium pyrophosphate dehydrate deposition.15 Inflammatory disc degeneration with erosive changes may also mimic infectious spondylodiscitis.