Pseudogout, an unconventional imitator of the lumbosacral spine with associated chronic epidural hematoma: illustrative cases

Stephen Jaffee,Shahed Elhamdani,Alexander Yu,Seung Won Jeong,Rocco Dabecco

doi:10.3171/case21571

Stephen Jaffee, Shahed Elhamdani + Show 3 more

Open Access

https://doi.org/10.3171/case21571

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Abstract

BACKGROUNDPseudogout, or calcium pyrophosphate dihydrate (CPPD) disease, is an inflammatory joint disease that most commonly involves the joints of the knees, ankles, and wrists. Pseudogout has also been known to involve the spine, especially the atlanto-occipital joint of the cervical spine, but there is limited documentation of its involvement in the lumbar spine. Though the atypical presentation of spinal pseudogout with findings consistent with discitis and epidural abscess has been documented, its presentation with associated chronic spinal epidural hematoma is a rare entity.OBSERVATIONSThe authors present two separate cases of pseudogout involvement of the lumbar spine, one case presenting with a clinical and radiographic picture consistent with discitis and epidural abscess and the other with radiographic and operative findings consistent with a chronic epidural hematoma.LESSONSThis case series demonstrates rare and atypical presentations of pseudogout within the lumbosacral spine.

Highlights

Pseudogout, or calcium pyrophosphate dihydrate (CPPD) disease, is an inflammatory joint disease that most commonly involves the joints of the knees, ankles, and wrists
Pseudogout, known as calcium pyrophosphate dihydrate (CPPD) disease, is a pathology that entails the accumulation of calcium pyrophosphate crystals in articular or periarticular spaces resulting in inflammatory joint disease
There have been a few cases of spinal pseudogout mimicking infection/epidural abscess reported in the literature

Summary

BACKGROUND

Pseudogout, or calcium pyrophosphate dihydrate (CPPD) disease, is an inflammatory joint disease that most commonly involves the joints of the knees, ankles, and wrists. Though the atypical presentation of spinal pseudogout with findings consistent with discitis and epidural abscess has been documented, its presentation with associated chronic spinal epidural hematoma is a rare entity. Spinal CPPD disease most commonly involves the cervical spine, affecting the atlanto-occipital joint and resulting in cervico-occipital pain with fever, neck stiffness, and elevated inflammatory markers. Crystal deposition has been documented in the lumbar spine and rarely the thoracic spine with a wide range of pathological presentations ranging from compressive radiculopathy to cauda equina syndrome.[1] There have been a few cases of spinal pseudogout mimicking infection/epidural abscess reported in the literature. We report two cases of spinal pseudogout presenting as epidural abscess and chronic lumbar epidural hematoma. We hope that additional case reports may aid in the understanding of the pathological profile of pseudogout of the spine and guide future clinicians in developing effective and efficient means of diagnosing and subsequently treating patients with this condition

Illustrative Cases

Findings

Discussion