Pseudogout of the Knee after Intraarticular Injection of Hyaluronic Acid

Ho Seung Jeon; Young Kyun Woo; Seok Ha Hwang; Seung Pyo Suh; Joon Kyung Lee

doi:10.4055/jkoa.2014.49.6.476

Journal List > J Korean Orthop Assoc > v.49(6) > 1013340

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Jeon, Woo, Hwang, Suh, and Lee: Pseudogout of the Knee after Intraarticular Injection of Hyaluronic Acid

Case Report

Journal of the Korean Orthopaedic Association 2014; 49(6): 476-479.

Published online: 30 December 2014

DOI: https://doi.org/10.4055/jkoa.2014.49.6.476

Pseudogout of the Knee after Intraarticular Injection of Hyaluronic Acid

Ho Seung Jeon, M.D., Young Kyun Woo, M.D., Seok Ha Hwang, M.D., Seung Pyo Suh, M.D., Joon Kyung Lee, M.D.

Department of Orthopedic Surgery, Sung-Ae Hospital, Seoul, Korea.

Correspondence to: Seung Pyo Suh, M.D. Department of Orthopedic Surgery, Sung-Ae Hospital, 22 Yeouidaebang-ro 53-gil, Yeongdeungpo-gu, Seoul 150-960, Korea. TEL: +82-2-840-7235, FAX: +82-2-840-7755, arcseo@hanmail.net

Received 24 January 2014 Revised 8 April 2014 Accepted 8 May 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

An 82-year-old woman underwent surgery for the left intertrochanteric fracture. However, during hospitalization, she complained of pain on the right knee. Radiographs showed moderately degenerative arthritis and intrameniscal calcification. Hyaluronic acid was administered by intraarticular injection. After injection, arthritic symptoms improved. Five days after injection, she complained of severe pain, swelling, and heating sensation in the right knee with chills and fever. Blood test showed elevated white blood cell (WBC) count and C-reactive protein. WBC in synovial fluid increased to 47,250/mm³. Antimicrobial therapy was administered under the impression of acute pyogenic arthritis by adverse reaction of hyaluronic acid injection. Polarization microscope showed calcium pyrophosphate dihydrate crystals. Synovial fluid culture was negative. Finally, she was diagnosed as pseudogout. The symptoms improved within one week. To our knowledge, there has been no report of pseudogout following intraarticular injection of hyaluronic acid in Korea. Therefore, we report this case with a review of the literature.

Keywords: knee, intra-articular injections, hyaluronic acid, chondrocalcinosis

Figures and Tables

Figure 1

Radiographs of both knees show intrameniscal calcification, indicating chondrocalcinosis.

Figure 2

Aspirated synovial fluid from the knee shows thick, turbid fluid.

Figure 3

Polarization microscope shows rhomboid and rod shaped crystals with positive birefringence.

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