Authors: Viorela Mihaela Ciortea1,2, László Irsay1,2, Anca Purcar-Popescu2, Adela Raluca Nistor2, Adrian Florea3, Liliana Rogojan4, Ileana Monica Borda1,2, Alina Deniza Ciubean1, Rodica Ana Ungur1,2
1Department of Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
2Department of Rehabilitation, Rehabilitation Clinical Hospital, Cluj-Napoca, Romania
3Department of Cellular and Molecular Biology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
4Department of Pathological Anatomy, Emergency Clinical County Hospital, Cluj-Napoca, Romania
Background. Calcium pyrophosphate deposition disease (CPPD) is an arthropathy that affects the synovium and periarticular tissues. More often, persons aged over 50 years old suffer from this disease. CPPD pathogenesis is not yet completely understood. In younger patients, the suspicion of familial predisposition or a metabolic disease is raised. Imaging tests and aspirate analysis from tendon in optical microscopy are essential for establishing an accurate positive diagnosis.
Case presentation. We report a case of a 45-year-old female patient, without significant personal pathological history, with atypical periarticular location of calcium pyrophosphate deposition in the supraspinatus tendon. This deposition was evidenced by X-ray and ultrasound, and then confirmed by the analysis of the aspirate from the tendon, in optical microscopy. The patient received nonsteroidal anti-inflammatory drugs, physiotherapy of the shoulder, local infiltration with betamethasone and lidocaine, with a favorable evolution.
Conclusions. This case is a rare one due to the following particularities: the patient has an age below the average age for this pathology; the atypical location of a single calcium pyrophosphate deposition in the supraspinatus tendon, a tendon that is usually correlated with hydroxyapatite deposition. The presented case highlights the importance of imaging examinations and aspirate analysis using optical microscopy in establishing the positive diagnosis of calcium pyrophosphate deposition disease.
Key words: calcium pyrophosphate deposition disease, supraspinatus tendon, imaging tests, optical microscopy, young patient13-ciortea-irsay199-202