Abstract
Introduction.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.
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.
| Original language | English |
|---|---|
| Pages (from-to) | 564 |
| Number of pages | 1 |
| Journal | Medicina (Kaunas) |
| Volume | 59 |
| Issue number | Suppl. 2 |
| Publication status | Published - 29 Mar 2023 |
| Event | RSU Research Week 2023: Research Week 2023 Rīga Stradiņš University - Riga Stradins University, Riga, Latvia Duration: 27 Mar 2023 → 31 Mar 2023 https://rw2023.rsu.lv/general-information https://rw2023.rsu.lv |
Keywords*
- Milwaukee shoulder
- Calcific enthesopathy
- SPINAL CANAL STENOSIS
Field of Science*
- 3.2 Clinical medicine
Publication Type*
- 3.4. Other publications in conference proceedings (including local)