Jt. Kelley et al., Fever with acute arthritis in calcium pyrophosphate dihydrate deposition disease: A missed explanation for altered mental status in elderly patients?, JCR-J CLIN, 7(5), 2001, pp. 322-325
Calcium pyrophosphate dihydrate (CPPD) deposition disease is a relatively c
ommon condition primarily affecting the elderly. Various clinical presentat
ions ranging from an acute arthritis resembling gout (pseudogout) to fever
of unknown origin have been reported.
We describe four elderly patients with fever and altered mental status. Eac
h patient underwent an extensive unrevealing work-up. An acute arthritis mi
ssed by the health-care team in their initial evaluation was later identifi
ed, leading to rheumatologic consultation and subsequent diagnosis of CPPD
disease after joint aspiration and synovial fluid analysis. Defervescence a
nd resolution of mental status changes occurred after improvement of the ar
Awareness that CPPD disease may present with systemic symptoms, including f
ever and altered mental status, may assure careful examination of joints an
d can prevent unnecessary testing and diagnostic delay.