We report a case of large medial meniscal cyst responsible for symptomatic saphenous nerve compression in a 49-year-old male with a history of mild trauma to the affected knee. We are not aware of any similar cases in the literature. The lesion was delineated by ultrasonography and even more clearly by magnetic resonance imaging. At surgery, the saphenous nerve was seen to be displaced by the cyst. Cystectomy and partial meniscectomy were performed. The outcome was favorable.
Summary A patient presenting with destructive arthropathy of the proximal interphalangeal (PIP) joints of the hands is described. She was initially believed to have rheumatoid arthritis but non-steroidal anti-inflammatory drugs were of no help. The patient was subsequently found to have hypothyroidism and erosive osteoarthritis of the fingers. Joint swelling, pain and stiffness responded dramatically to thyroid hormone substitution. The PIP joint spaces reappeared on the radiographs within 9 months. This case suggest that hypothyroidism may induce destructive arthropathy of the finger joints. As thyroxine replacement may reverse the rheumatic complaints, hypothyroidism should be considered in the differential diagnosis of a destructive arthropathy of unclear aetiology.
### CASE 1
A 74 year old white man presented with an abrupt onset of metacarpophalangeal (MCP) and interphalangeal (IP) joint pains associated with swelling of both hands. He had two hours of morning stiffness but no other joint complaints or history of constitutional symptoms. Past medical history was unremarkable except for diabetes mellitus type 2 treated with oral antidiabetic drugs.#### Key points
Examination showed gross pitting oedema of the dorsum of both hands with swollen and tender MCPs, severe tenosynovitis of the flexor tendons, and swollen and limited wrist movements. Both knees had painless small effusions. Other joints showed no signs of inflammation and no nodules were palpated.
The erythrocyte sedimentation rate was increased at 55 mm in the first hour. Except for a mild inflammatory anaemia and hyperglycaemia between 8 to 10 mmol/l, the full blood count, renal, liver and thyroid function tests were within normal limits. Electrophoresis demonstrated an acute and subacute inflammatory pattern without monoclonal peak and rheumatoid factor and ANA were negative. Four millilitres of clear synovial fluid were aspirated from the left knee. Cell count was 198/mm3 with no crystals.
The patient was treated with prednisone with a rapid clinical response. Maximal dose was 20 mg per day, slowly tapered over four months to zero. No flare up was observed and after two years the patient was still …
Propionibacterium acnes, a gram positive anaerobic organism, is a component of normal skin flora. It can exceptionally be a source of osteoarticular infection (osteitis, arthritis, spondylodiscitis). We report a case of Propionibacterium acnes spondylodiscitis following lumbar puncture. This observation should alert the clinician to the fact that Propionibacterium acnes may rarely cause spondylodiscitis and lumbar pain, and should be considered a causative agent of bone infections after local procedures.
A patient was shown to have acute arthritis in a metacarpophalangeal joint, with local calcification indicated by x-rays. Surgical and pathological examinations showed strictly intra-articular apatite crystal deposits and an erosive osteoarthritis. These crystal deposits could account for the synovial inflammation; they are thought to be related to bone fragments embedded in the synovium. The predisposing role of previous local injections of corticosteroids is debatable.
Hyperuricaemia and gout have been reported in organ transplant patients treated with cyclosporin, an immunosuppressant inhibiting calcineurin.1,2 Tacrolimus, another calcineurin inhibitor, is nowadays widely used in place of cyclosporin. Hyperuricaemia has been seen in patients receiving tacrolimus3 but, to our knowledge, only rare cases of gout have been mentioned so far.4
Since 1998, 31 patients (22 men, 9 women; current mean age 53 years (range 24–67)) have regularly received tacrolimus for immunosuppression after liver transplantation in the surgical department of Lausanne University Hospital. The mean duration of follow up with tacrolimus treatment was 27.8 months (range 7–57).
In two cases the first manifestations of gout appeared after liver transplantation when these two patients were receiving tacrolimus for immunosuppression.
### Patient 1
A 31 year old man received a liver transplant in November 1998. He was treated …
Calcium pyrophosphate dihydrate (CPPD) deposits, answerable for chondrocalcinosis, are frequently observed in elderly people. Involvement of the spine is not rare. We present the case of a woman hospitalised for an acute arthritis of the right knee related to CPPD crystal deposition disease who suffered from acute neck pain. The computerised tomography showed calcified deposits in the transverse ligament of the atlas highly suggestive of CPPD deposits. This localisation seems to be very common for CPPD deposits. These CPPD crystal deposits may induce pseudo-meningitic attacks or chronic mechanical neck pain. CPPD crystal deposits in the upper cervical spine should be diagnosed when the disease is quiet, in order to avoid unnecessary investigations and therapies when an acute cervical flare occurs.
