ピロリン酸カルシウム沈着症（CPPD）の2例が脊椎脊髄炎を呈した

Two cases of calcium pyrophosphate deposition disease (CPPD) presented with spondylodiscitis.

• Tuğba İzci Duran
• Metin Özgen

抄録

ピロリン酸カルシウム沈着症（CPPD）は結晶性関節症であり、無症状のCPPD、CPPDを伴う変形性関節症、急性CPPD結晶性関節炎（旧仮性グアウト）、慢性CPPD結晶性炎症性関節炎など、様々な臨床症状を呈することがある。CPPDの主な危険因子は、加齢、外傷、変形性関節症であることが知られています。急性CPP関節炎は単関節性または乏関節性として発生し、通常、膝、手首、足首などの大きな末梢関節を侵す。CPPDは突然の激しい痛み、腫脹、関節周囲紅斑の発症が特徴で、発熱、悪寒、脱力感などの全身症状が現れることがあります。一方、軸性CPPDは報告例が少なく、ほとんどの症例がマグナム孔症候群、脊椎狭窄症、橈骨症、骨髄症、滑膜嚢腫、馬尾赤道症候群などの腫瘤に関連した症状を伴って出現します。また、頚部や腰部の痛みを引き起こす脊椎CPPDの報告例は少ない。急性頸部・腰痛の鑑別診断では、この臨床状態を考慮すべきである。

Calcium pyrophosphate deposition disease (CPPD) is a crystal arthropathy, and may present with various clinical manifestations such as asymptomatic CPPD, osteoarthritis with CPPD, acute CPPD crystal arthritis (formerly pseudogout), and chronic CPPD crystal inflammatory arthritis. It is known that aging, trauma and osteoarthritis are major risk factors for CPPD. Acute CPP arthritis may occur as monoarticular or oligoarticular and usually involves large peripheral joints such as the knees, wrists and ankles. CPPD is characterized by sudden onset of severe pain, swelling and periarticular erythema, and systemic symptoms such as fever, chills, and weakness may occur. On the other hand, axial CPPD has been reported rarely and most cases appear with symptoms related to a mass effect such as foramen magnum syndrome, spinal stenosis, radiculopathy, myelopathy, synovial cyst or cauda equina syndrome. In addition, there are fewer reported cases of spinal CPPD that cause neck and back pain. This clinical condition should be considered in the differential diagnosis of acute neck and back pain.