Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jun;42(6):1105-1112.
doi: 10.1007/s00296-021-04828-0. Epub 2021 Mar 11.

Calcium pyrophosphate deposition (CPPD) in a liver transplant patient: are hypomagnesemia, tacrolimus or both guilty? A case-based literature review

Simon Cadiou  1 , Antonia Le Gruyer  2 , Baptiste Giguet  3 , François Robin  4 , Morgane Milin  5 , Xavier Guennoc  5 , Pascal Guggenbuhl  4   6 , Marine De Saint-Riquier  5
Affiliations
Free article
Review

Calcium pyrophosphate deposition (CPPD) in a liver transplant patient: are hypomagnesemia, tacrolimus or both guilty? A case-based literature review

Simon Cadiou et al. Rheumatol Int. 2022 Jun.
Free article

Abstract

Calcium pyrophosphate deposition (CPPD) can be induced by a persistent hypomagnesemia. Tacrolimus is an immunosuppressive treatment especially used in organ transplant, potentially inducer of hypomagnesemia by renal loss. A 53-year-old man, liver transplant 10 months earlier, developed an acute peripheral oligoarthritis of wrist, hip and elbow with fever, associated with acute low back pain. Synovial fluid was sterile, and revealed calcium pyrophosphate crystals. Spinal imaging showed inflammatory changes. Magnesium blood level was low at 0.51 mmol/l, with high fractional excretion in favor of renal loss. Tacrolimus was changed for everolimus, proton pump inhibitor was stopped, and magnesium oral supplementation was started. After 8 months follow-up and slow prednisone tapering, he did not relapse pain. Persistent hypomagnesemia is a rare secondary cause of CPPD. In this entity, drug liability should be investigated such as tacrolimus in organ transplant patient.

Keywords: CPPD; Crystal; Liver transplant; Magnesium; Pyrophosphate calcium; Spondylodiscitis; Tacrolimus; Vertebral osteomyelitis.

PubMed Disclaimer

References

    1. Rosenthal AK, Ryan LM (2016) Calcium pyrophosphate deposition disease. N Engl J Med 374:2575–2584. https://doi.org/10.1056/NEJMra1511117 - DOI - PubMed - PMC
    1. Moshrif A, Laredo JD, Bassiouni H et al (2019) Spinal involvement with calcium pyrophosphate deposition disease in an academic rheumatology center: a series of 37 patients. Semin Arthritis Rheum 48:1113–1126. https://doi.org/10.1016/j.semarthrit.2018.10.009 - DOI - PubMed
    1. Grobost V, Vayssade M, Roche A et al (2014) Axial calcium pyrophosphate dihydrate deposition disease revealed by recurrent sterile spondylodiscitis and epidural abscess. Joint Bone Spine 81:180–182. https://doi.org/10.1016/j.jbspin.2013.07.007 - DOI - PubMed
    1. Jones AC, Chuck AJ, Arie EA et al (1992) Diseases associated with calcium pyrophosphate deposition disease. Semin Arthritis Rheum 22:188–202. https://doi.org/10.1016/0049-0172(92)90019-a - DOI - PubMed
    1. Ea H-K, Blanchard A, Dougados M, Roux C (2005) Chondrocalcinosis secondary to hypomagnesemia in Gitelman’s syndrome. J Rheumatol 32:1840–1842 - PubMed