Hydroxyapatite Crystal deposition disease with multiple joint involvement resulting in spinal canal severe stenosis: case report

Description

Hydroxyapatite crystal deposition disease (HADD) is a condition characterised by periarticular and intra-articular calcium deposits in surrounding soft tissue with an accompanying inflammation. Etiology is uncertain, common predisposing factors include repetitive microtrauma, ischemia and other diseases such as renal failure. Commonly, the glenohumeral joint is affected. Other locations include elbow, wrist, knee, foot, and spine. The presence of a typical calcified deposit seen on CT and/or MRI is sufficient to establish the diagnosis of HADD.
Case description.A 34-year-old male addmited to the hospital after suffering from a recurrent fever and elevated inflammatory markers for the past few months. The patient has a history of chronic kidney disease treated with hemodialysis; anabolic-androgenic steroid use; multiple calcium depositions along glenohumeral, iliofemoral joints bilaterally, left foot and lumbar spine. Conservative analgesic and empiric antibacterial therapy was ineffective. Non-enhancement CT showed hyperdense calcifications in soft tissue along lumbar spine with minimal intraspinal localization. Over the course of a few weeks, symptoms worsened, the patient presented with lower back pain that radiated to legs, progressive weakness of legs, paraparesis without sensory deficit. MRI scans showed hypointense periarticular lesions with fluid levels on both T1 and T2 weighted images from L1 to L3 extending intraspinally with severe spinal canal stenosis, medullary cone compression. The patient was addmited to Neurosurgery unit and underwent resection of lumbar calcified depositions. On pathologist’s report excisional biopsy showed chronic inflammation with calcification.
Summary.The reported case demonstrates severe spinal stenosis, a rare complication of HADD, seen on MRI, with paraparesis and an effective treatment with neurosurgical resection.
Conclusions. HADD can cause local inflammation, swelling and compression causing severe pain and immobility. Described patient had an increased risk of crystal deposition development due to chronic kidney disease and history of anabolic-androgenic steroid use.

Period	30 Mar 2023
Event title	RSU International Research Conference 2023: Knowledge for Use in Practice
Event type	Conference
Organiser	Rīga Stradiņš University
Location	Riga, LatviaShow on map
Degree of Recognition	International