Windswept Deformity from pseudogout. A Diagnostic Challenge of an extreme presentation, a case report.

Abstract

Background: Twenty percent of the population globally is affected by musculoskeletal conditions. These conditions significantly impair mobility and dexterity. Pseudogout is similarly a debilitating disease that significantly increases morbidity and the disability adjusted life years. We report a case of pseudogout in its advanced stage, causing total joint destruction of the knees and shoulders, which manifested and presented as a windswept deformity. The Case: Our patient is a 69 year old man who complained of bilateral knee pain, shoulder pain during active flexion and an obvious knee deformity. His familial history was not significant, and there was no history of injuries, infection or congenital diseases. His knees were severely deformed, with extremely laxed collateral ligaments. Both of his shoulders had a limited range of movement with coarse crepitation on passive movement. X-ray of his knees showed a completely destroyed joint, reduced joint space, subchondral cysts and chondrocalcinosis. X-ray of his shoulder joint showed a subluxated joint, subchondral cyst and subchondral sclerosis. His joint aspirate had positive rhomboid crystals on the birefringence test, consistent with pseudogout. Joint replacement surgery is the definitive management, but the patient and caretaker were not able to afford the implants. Conclusion: We discussed the diagnosis of pseudogout in this patient and how the policies in place do not provide adequate coverage for these populations. This marginalizes those who need surgery and limits their access to affordable surgical care when needed.