Pseudogout or pseudolymphoma? Calcium pyrophosphate deposition disease of the cervical spine: a rare presentation and literature review

Abstract

Calcium pyrophosphate deposition (CPPD) disease is a crystal arthropathy primarily affecting peripheral joints, most commonly the wrist and the knees. However, CPPD in the cervical spine is a rare entity. This report describes a case of CPPD of the cervical spine which presents with symptoms of neck pain and brachalgia. A 62-year-old woman presented with left-sided upper limb and neck pain. MRI scanning revealed a low signal abnormality within the C6 and C7 vertebrae, and the possibility of lymphoma was raised. The patient was recalled for gadolinium-enhanced scans which showed perivertebral and marrow enhancement. Fine-needle aspirate histology initially suggested a spindle cell tumour or lymphoma. However, CT-guided biopsy showed positively birefringent crystals, confirming CPPD. CPPD of the spine is a rare differential of nerve impingement in the cervical spine when MRI scanning perivertebral signal enhancement. Furthermore, CPPD of the spine can mimic malignancy.

Cervical myelopathy due to subaxial calcium pyrophosphate dihydrate (CPPD) deposition with simultaneous asymptomatic crowned dens syndrome: two case reports

“…CPPD deposition of the spine, including CDS, has been previously described, but it is very unusual in the lower cervical spine [ 2 , 3 , 5 , 14 , 15 ]. There are very few reports of cervical myelopathy caused by subaxial CPPD deposition and there has been no report on cervical myelopathy by subaxial CPPD deposition with simultaneous asymptomatic CDS at the same time.…”

“…Calcification can occur at not only the cruciform ligament but also the transverse, alar and apical ligaments [ 8 – 13 ]. Cervical CPPD deposition may produce a unique type of neck pain from the suboccipital region to the posterior neck bilaterally with restricted motion in rotation [ 2 , 17 – 21 ]. Furthermore, compressive cervical myelopathy can manifest, especially when CPPD deposition occurs at the ligamentum flavum [ 14 , 15 ].…”

A case of acute calcium pyrophosphate arthritis in two rare sites of involvement: The cervical facet and atlantoaxial joint

“…[1,11] The facet joints are also affected. [4][5][6][7][8][9] Calcium pyrophosphate dihydrate deposition can be a cause of symptomatic spinal stenosis associated with cyst formation in a facet joint. [5][6][7] Moreover, CPPD within the ligaments can be associated with spinal stenosis.…”

“…[ 3 ] However, there are very few reports in the literature of CPPD in the spine. [ 4 - 9 ] Calcium pyrophosphate dihydrate deposition crystals may be found in several spinal structures including the ligamentum flavum, posterior longitudinal ligament, atlanto-occipital ligament, joint capsules, synovium, articular cartilage and the intervertebral discs. [ 4 ] Calcium pyrophosphate dihydrate deposition in the atlantoaxial joint leads to erosive and destructive changes with atlantoaxial subluxation in some patients.…”

“…[ 3 ] However, CPPD disease in the spine is a rare entity. [ 4 - 9 ] This article describes the case of a patient with neck pain who was diagnosed as CPPD of the atlantoaxial joint and right C4-C5 facet joint with radiological findings.…”