{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:40:02Z","timestamp":1756323602854,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,8,9]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:p>This case report details a rare instance of calcium pyrophosphate dihydrate crystal deposition disease (CPPD), commonly known as pseudogout, affecting the lumbar spine. A man in his mid-50s of age presented with severe low-back pain and fever, initially suspected as a spinal infection. Elevated erythrocyte sedimentation rate and leucocytosis were observed, while the initial imaging showed only lumbar spondylosis with arthritic changes in the right L4\u2013L5 facet joint. However, an MRI revealed a cystic lesion at the right L5\u2013S1 facet joint without signs of spondylodiscitis. Ultrasound-guided needle aspiration and synovial fluid analysis, including polarised light microscopy, identified calcium pyrophosphate crystals. Treatment with intravenous pain management was initially ineffective. Confirmation of CPPD led to successful treatment with oral colchicine, resulting in rapid pain alleviation and fever reduction. The patient reported significant improvement at a 2-week follow-up. This case emphasises the importance of thorough investigation in differentiating common symptoms and avoiding unnecessary treatments, highlighting the role of histological examination in diagnosing rare conditions like spinal CPPD.<\/jats:p>","DOI":"10.1136\/bcr-2024-259628","type":"journal-article","created":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T01:29:15Z","timestamp":1726450155000},"page":"e259628","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Differential diagnosis of pseudogout of the lumbar spine"],"prefix":"10.1136","volume":"17","author":[{"given":"Ishthayapong","family":"Kanjanakeereewong","sequence":"first","affiliation":[{"name":"Division of Orthopedic, Golden Jubilee Medical Center,Faculty of Medicine Siriraj hospital, Nakorn Pathom, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panlop","family":"Tirawanish","sequence":"additional","affiliation":[{"name":"Division of Orthopedic, Golden Jubilee Medical Center,Faculty of Medicine Siriraj hospital, Nakorn Pathom, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siravich","family":"Suvithayasiri","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Chulabhorn Hospital, Bangkok, Thailand"},{"name":"Bone and Joint Excellence Center, Thonburi Hospital, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monchai","family":"Ruangchainikom","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,9,13]]},"reference":[{"key":"2025082711593823000_17.9.e259628.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.62.6.513"},{"key":"2025082711593823000_17.9.e259628.2","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1002\/acr.23160","article-title":"Calcium Pyrophosphate Deposition Disease and Associated Medical Comorbidities: A National Cross-Sectional Study of US Veterans","volume":"69","author":"Kleiber Balderrama","year":"2017","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025082711593823000_17.9.e259628.3","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2010.182"},{"key":"2025082711593823000_17.9.e259628.4","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-199405000-00022"},{"key":"2025082711593823000_17.9.e259628.5","doi-asserted-by":"crossref","first-page":"246","DOI":"10.4081\/reumatismo.2011.246","article-title":"Calcium pyrophosphate deposition disease: clinical manifestations","volume":"63","author":"Ferrone","year":"2012","journal-title":"Reumatismo"},{"key":"2025082711593823000_17.9.e259628.6","doi-asserted-by":"publisher","DOI":"10.1177\/230949900701500122"},{"key":"2025082711593823000_17.9.e259628.7","doi-asserted-by":"crossref","first-page":"2575","DOI":"10.1056\/NEJMra1511117","article-title":"Calcium Pyrophosphate Deposition Disease","volume":"374","author":"Rosenthal","year":"2016","journal-title":"N Engl J Med"},{"key":"2025082711593823000_17.9.e259628.8","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.139105"},{"key":"2025082711593823000_17.9.e259628.9","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-56-5-738"},{"key":"2025082711593823000_17.9.e259628.10","doi-asserted-by":"publisher","DOI":"10.1002\/art.24774"},{"key":"2025082711593823000_17.9.e259628.11","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1016\/j.radcr.2022.10.057","article-title":"Pseudogout of the lumbar spine","volume":"18","author":"Gupta","year":"2023","journal-title":"Radiol Case Rep"},{"key":"2025082711593823000_17.9.e259628.12","doi-asserted-by":"crossref","first-page":"7639","DOI":"10.2147\/IJGM.S360714","article-title":"Lumbar Spinal Involvement in Calcium Pyrophosphate Dihydrate Disease: A Systematic Literature Review","volume":"15","author":"Ben Tekaya","year":"2022","journal-title":"Int J Gen Med"},{"key":"2025082711593823000_17.9.e259628.13","first-page":"331","article-title":"Mixed monosodium urate and calcium pyrophosphate crystal-induced arthropathy. 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