J Korean Orthop Assoc.  2014 Dec;49(6):476-479. 10.4055/jkoa.2014.49.6.476.

Pseudogout of the Knee after Intraarticular Injection of Hyaluronic Acid

• Jeon HS
• Woo YK
• Hwang SH
• Suh SP
• Lee JK

• KMID: 2185162
• DOI: http://doi.org/10.4055/jkoa.2014.49.6.476

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.

Keyword

knee; intra-articular injections; hyaluronic acid; chondrocalcinosis

MeSH Terms

Aged, 80 and over
Arthritis
C-Reactive Protein
Calcium Pyrophosphate
Chills
Chondrocalcinosis*
Female
Fever
Heating
Hematologic Tests
Hospitalization
Hot Temperature
Humans
Hyaluronic Acid*
Injections, Intra-Articular*
Knee*
Korea
Leukocytes
Osteoarthritis
Sensation
Synovial Fluid
C-Reactive Protein
Calcium Pyrophosphate
Hyaluronic Acid

Figure

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  Figure 1 Radiographs of both knees show intrameniscal calcification, indicating chondrocalcinosis.

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  Figure 2 Aspirated synovial fluid from the knee shows thick, turbid fluid.

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  Figure 3 Polarization microscope shows rhomboid and rod shaped crystals with positive birefringence.

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