Bilateral Olecranon Bursitis - A Rare Clinical presentation of Calcium Pyrophosphate Crystal Deposition Disease

Abstract

Introduction: Calcium pyrophosphate crystal deposition disease (CPPD) is the most common form of crystal arthropathy second only to gout. Common clinical presentation is an acute monoarticular arthritis commonly occurring in knee joints. We presented a case of bilateral olecranon bursitis in a calcium pyrophosphate crystal deposition disease.

Case report: A 42-year-old female patient is presented with golf ball sized painless swellings in the posterior aspect of her elbows. Elbow joints were clinically normal except for restriction of terminal flexion. X-ray showed mild erosion at the tip of olecranon. Excision biopsy of the swelling showed positive birefringent calcium pyrophosphate dehydrate crystals on the inner wall of the specimen on polarized light microscopy.

Conclusion: Bilateral olecranon bursitis may be part of the extraarticular manifestations of calcium pyrophosphate dihydrate crystal deposition disease with good prognosis following in toto bursa excision.

Keywords: Calcium pyrophosphate; Crystal deposition disease; Elbow; Olecranon Bursitis.

Figure 1 (a) and 1(b)

Front and dorsal view of the forearm on presentation showing the bite wounds.

Figure 2

X-ray of elbow AP and lat views showing olecranon tip erosion with normal joint space.

Figure 3

Intraoperative photograph showing the bursal mass with discrete yellow crystals.

Figure 4 (a) and 4(b)

Gross specimen showing the bursal sac with yellow crystals

Figure 5

Hematoxylin-eosin-stained sections, under ordinary light, original magnification X50.

Figure 6

Wall of bursa. CPPD crystal deposits on the inner surface. Crystals in layers with underlying birefringent fibrous bundles (unstained sections under polarized light).

Figure 7 (a) and 7(b)

Postoperative photograph showing healed operative scar with full flexion

Figure 8 (a) and 8(b)

Gross specimen showing the bursal sac with yellow crystals

Figure 9 (a) and 9(b)

Follow-up x-rays after 1 year shows no calcification

Figure 7 (a) and 7(b)

Postoperative photograph showing healed operative scar with full flexion