Bilateral sclerochoroidal calcification in a patient with calcium pyrophosphate deposition disease.

Abstract

A 60-year-old woman presented with pain and swelling in both of her knees and received a diagnosis of CPPD, based on her clinical characteristics, detection of chondrocalcinosis in multiple joints (including knees and shoulders) (Fig. 1A, B), and a synovial biopsy that was consistent with chondrocalcinosis. The disease was considered to be idiopathic, as she had no other underlying systemic disorders, such as hyperparathyroidism. She was put on colchicine (1.5 mg/day) and (on an as-needed basis) on NSAIDs. The patient was referred to the ophthalmology department because she has longstanding subtle visual complaints. On fundoscopic examination, she had creamy coloured lesions associated with some retinal pigment alterations (Fig. 1C1–C2). An orbital CT scan demonstrated that these lesions were calcified (Fig. 1C3). CPPD is a form of crystal-induced arthritis and it targets the musculoskeletal system. Other system involvements are quite unusual. Eye involvement has only been reported in two cases and has been characterized by sclerochoroidal calcification [1]. Sclerochoroidal calcification may even interfere with the visual function, especially when the deposition is extensive. Moreover, depositions may mimic intraocular tumours, such as a choroidal melanoma [2]. In light of the present case, routine ophthalmic examination should be performed in cases with CPPD, and CPPD should be considered in the differential diagnosis of cases with sclerochoroidal calcification, in addition to the more common causes, such as hyperparathyroidism, parathyroid adenoma, Gitelman syndrome and Bartter syndrome [3]. Informed consent was provided for the publication of this manuscript.