Pseudogout mimicking cervical spine osteomyelitis and ventral epidural abscess: A case report and literature review
- Department of Neurosurgery, State University of New York (SUNY) Upstate Medical University, Syracuse,
- Department of Neurosurgery, Lake Erie College of Osteopathic Medicine, Elmira, United States.
Brandon Michael Wilkinson, Department of Neurosurgery, State University of New York (SUNY) Upstate Medical University, Syracuse, United States.
DOI:10.25259/SNI_975_2023Copyright: © 2024 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Brandon Michael Wilkinson1, Dan Y. Draytsel1, Fakhri B. Awawdeh2, Ali Hazama1. Pseudogout mimicking cervical spine osteomyelitis and ventral epidural abscess: A case report and literature review. 05-Jan-2024;15:5
How to cite this URL: Brandon Michael Wilkinson1, Dan Y. Draytsel1, Fakhri B. Awawdeh2, Ali Hazama1. Pseudogout mimicking cervical spine osteomyelitis and ventral epidural abscess: A case report and literature review. 05-Jan-2024;15:5. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=12696
Background: Calcium pyrophosphate deposition disease (CPPD), also known as “pseudogout,” is a crystal deposition arthropathy involving the synovial and periarticular tissues. Pseudogout rarely presents in the axial spine. Here, we present the case of an 80-year-old female patient admitted after a mechanical fall, initially misdiagnosed on computed tomography (CT)/magnetic resonance studies with cervical osteodiscitis/ventral epidural abscess that proved to be pseudogout.
Case Description: An 80-year-old female was admitted after a mechanical fall. The initial cervical CT scan showed multilevel degenerative changes with an acute C6 anterior wedge compression fracture, focal kyphosis, C5-6 disc space collapse, and endplate destruction. The magnetic resonance imaging showed marked contrast enhancement of the C5-6 vertebral bodies and disc space. An interventional radiology-guided biopsy of the C5-6 vertebral bodies and disc space was consistent with calcium pyrophosphate deposits, was diagnostic for pseudogout, and was negative for infection. She was managed conservatively with a rigid collar and seven days of oral prednisone.
Conclusion: CPPD involvement in the axial spine is rare. Prompt pathologic diagnosis should be pursued to rule out an infectious process.
Keywords: Cervical spine, Osteomyelitis, Pseudogout
Calcium pyrophosphate deposition disease (CPPD) is a crystal deposition arthropathy involving the synovial and periarticular tissues.[
Here, we describe a rare case in which a female patient presented after a mechanical fall with neurological deficits and imaging findings mimicking cervical osteomyelitis with ventral epidural abscess, found to be CPPD.
An 80-year-old female was admitted after a mechanical fall. On examination, she only exhibited pain-limited weakness in the right lower extremity. The cervical computed tomography scan showed an acute anterior wedge compression fracture at C6, causing focal kyphosis, with associated C5-6 disc space collapse and endplate destruction concerning possible osteomyelitis/discitis [
(a) A sagittal computed tomography scan of the cervical spine shows an acute anterior wedge compression fracture at C6 with associated C5-6 disc space collapse and endplate destruction. Kyphotic alignment and chronic C3-4 anterolisthesis are noted. (b) An axial computed tomography scan of the cervical spine at the C5-6 disc space level shows endplate destruction.
(a) Sagittal T1-weighted magnetic resonance imaging (MRI) of the cervical spine with contrast showing avid homogenous enhancement of the C5-6 vertebral bodies and disc space, ventral epidural space, and posterior soft tissues from C2-C6. (b) Axial T1-weighted MRI of the cervical spine with contrast at the C5-6 disc space level, showing ventral epidural enhancement and severe spinal canal stenosis.
She was started on empiric antibiotics and underwent interventional radiology (IR)-guided biopsy of the C5-C6 vertebral bodies and disc space that revealed calcium pyrophosphate deposits without evidence of infection. Her antibiotics were stopped, and she was treated with a 7-day course of oral prednisone, 40 mg daily. Her fractures were managed conservatively with a rigid collar. At 1-month follow-up, she remains without new symptoms or signs of myelopathy.
The presence of pseudogout in the cervical spine causing neurologic symptoms is rare, with few cases reported in the literature. Ehioghae et al. reviewed a total of 20 clinical studies, including 69 patients with cervical spinal cord compression secondary to the presence of CPPD in the ligamentum flavum.[
Pseudogout involvement of the anterior spinal column has seldom been reported. Mikhael et al. reported a 60-year-old male with intractable low back pain and bilateral lower extremity radiculopathy.[
The radiographic findings of endplate destruction and avid contrast enhancement of the disc space and vertebral bodies on MRI in our patient are often classic signs of osteodiscitis. Our patient underwent an IR-guided biopsy revealing CPPD that was effectively treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.
CPPD involvement in the axial spine is rare. We present an 80-year-old female patient with radiographic findings mimicking cervical osteodiscitis/ventral epidural abscess that proved to be CPPD following an IR-guided biopsy. She was effectively treated with steroids and NSAIDs.
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The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
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