Hypomagnesemia has been associated with deposition of calcium pyrophosphate dihydrate crystals in articular structures, causing pseudogout, also known as calcic gout. Occasionally, pseudogout may mimic septic arthritis; this “pseudoseptic” attack may be of especial concern in the immunocompromised host, such as transplant recipient patients, who may be indeed at risk of developing septic arthritis. We report the cases of two patients in whom pseudogout developed after liver transplantation. Synovial fluid appearance and leukocyte counting in synovial fluid mimicked septic arthritis, but calcium pyrophosphate dihydrate crystals were observed. Magnesium depletion before transplantation and further tacrolimus-induced renal magnesium leakage were probably working in these patients.
Rheumatology Section, Hepatology Unit and Hepatic Transplant Surgical Unit, Hospital de Cruces; and Rehabilitation Division, Hospital de Gorliz, Pais Vasco, Spain
1 Address correspondence to: Dr. F. Perez-Ruiz, Sección de Reumatología, Hospital de Cruces, Plaza Cruces sin nūmero 48903 Barakaldo, Pais Vasco, Spain. E-mail: fperezhcru.osakidetza.net.
2 Rheumatology Section, Hepatology Unit, Hospital de Cruces.
3 Hepatic Transplant Surgical Unit, Hospital de Cruces.
4 Rehabilitation Division, Hospital de Gorliz.
Received 23 March 2000.
Accepted 5 June 2000.