Calcium pyrophosphate crystal deposition disease (CPPD), also known as
pseudogout, with spinal involvement, is associated with clinical manifestations of acute nerve compression or chronic
spinal stenosis. Precipitation of crystals of
calcium pyrophosphate dihydrate in connective tissues can lead to acute inflammatory
arthritis, degenerative chronic
arthropathies, and radiographic evidence of cartilage calcification. We present a case of an 87-year-old woman, with unstudied chronic
polyarthralgia and symptomatic
orthostatic hypotension. It were documented acute
calcium pyrophosphate deposition wrist
arthritis, and cervical CT and MRI was suggestive of spinal involvement of CPPD. Workup excluded other causes of
OH. Surgical approach could be indicated to minimize the symptoms, but it was contra-indicated due to the patient's performance status, so histological diagnosis was not possible.
Muscle atrophy played an important part in the rapid progression of this insidious
chronic disease. Conservative and symptomatic treatment achieve scarce short-term clinical improvement. Spinal involvement of CPPD was thought to be rare but recent studies show a higher prevalence than expected. We call for attention to the extent of structural changes that may occur when not early diagnosed nor treated. High clinical suspicion is required and this is, to our knowledge, the first report of
orthostatic hypotension as a presentation of CPPD.