Acute low back pain due to pseudogout: Two case reports

Pseudogout is an acute arthritis induced by deposition of calcium pyrophosphate dihydrate deposition disease (CPPD) crystals in articular and periarticular structures, and tends to affect the peripheral joints including knees, ankles, shoulders, and others. It is generally treated with nonsteroidal anti-inflammatory drugs (NSAIDs). The deposition of CPPD at the spine is uncommon, and it is very rarely diagnosed as the cause of low back pain. We report two cases of pseudogout in the lumbar spine. These patients presented sudden-onset severe low back pain with some inflammatory symptoms. Magnetic resonance imaging and computed tomography scan revealed manifestations of chondrocalcinosis. We diagnosed pyogenic spondylitis and gave them antibiotics at first Histopathological features of their biopsy showed CPPD crystal, leading to a diagnosis of pseudogout and discontinuing antibiotic medication. Pseudogout of the spine is rare. However, it is important to recognize that pseudogout can serve as a cause of the low back pain and a differential diagnosis of pyogenic spondylitis.