Pseudogout Simulating Systemic Disease in the Elderly

Its Significance in Diagnostic Considerations in Fever

Abstract

Pseudogout is well known to be a great mimic of other rheumatic disorders. When accompanied by fever, it can also mimic systemic diseases. We describe, here, six elderly patients of pseudogout with fever as the most prominent manifestation. Six patients were all women, aged from 74 to 89 years, with a mean of 80 years. They had systemic temperature of more than 38°C and peripheral white blood cell counts of more than 10, 000per cubic millimeter. The erythrocyte sedimentation rate ranged from 65 to 164 millimeters in the first one hour. Attacks affected single joint in 2 patients and two or more joints in 4 patients. The characteristic roentgenographic changes of chondrocalcinosis were found in all cases. The weakly positive birefringent crystals in synovial fluid were demonstrated in all patients examined, four of six patients, using the compensated polarized light microscopy. All these patients were initially misdiagnosed as acute infection of other organs (pneumonia, pyelonephritis, biliary tract infection, etc) because of fever and leukocytosis. Therefore, five of the patients had been treated with antibiotics. After failing in antibiotics therapy, joint manifestations were reassessed and the diagnosis of pseudogout was established. Nonsteroidal anti-inflammatory agents were, then, administered in stead of antibiotics, resulting in rapid fall in fever and diminishing of arthralagia. Fever is not well recongized as an accompaniment of pseudogout. This general lack of awareness may lead to considerable diagnostic confusion, over-investigation, and delaying of the initiation of appropriate therapy. The greater awareness of this association, fever and pseudogout, in conjunction with a thorough joint examination should be necessary, especially in the elderly.