Disappearance of the Chondrocalcinosis Border in Arthritis of the Wrist: Important Role in Diagnostic Mistakes.

Abstract

We report a case of calcium pyrophosphate dihydrate crystal deposition (CPPD) disease presenting as acute arthritis of the left wrist. A 66-year-old woman with no significant family history was admitted with a 7-day history of swelling, persistent pain, and limitation of motion in her left wrist. She reported no recent trauma, surgery, or severe illness, and had no known comorbidities other than mild hypertension treated with low-dose thiazide diuretics. She was not on chronic glucocorticoids or other immunosuppressive drugs. Plain radiographs of her wrist, obtained during the initial days of arthritis, showed chondrocalcinosis in her left wrist. A diagnosis of pseudogout was made. After 30 days, a repeat X-ray demonstrated the disappearance of the chondrocalcinosis border in the left wrist; however, follow-up radiography revealed chondrocalcinosis in asymptomatic joint areas, such as the pubic symphysis and knees. With this case report, we highlight the important role of radiographs in the early diagnosis of CPPD disease. Radiographic detection of crystal deposition can occasionally be transient, and its disappearance may lead to diagnostic confusion. Identifying such changes early can help avoid misdiagnosis and inappropriate management.