Unusual and memorable

Case Number 26: Massive cholesterol crystal deposition: unusual location in rheumatoid arthritis

P V Balint¹, D Kane², R D Sturrock²

Series editor: Gary D Wright

¹ 3^rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
² Centre for Rheumatic Diseases, University Department of Medicine, Glasgow Royal Infirmary, UK

Correspondence to:
Correspondence to:
Dr D Kane, Centre for Rheumatic Diseases, University Department of Medicine, Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK;
dk44a@clinmed.gla.ac.uk

Keywords: rheumatoid arthritis; cholesterol crystals

The first 150 words of the full text of this article appear below.

A 71 year old white man with seropositive erosive rheumatoid arthritis (RA) for 28 years presented with swelling of the left ankle that had been increasing in size for three years and was now interfering with shoe fitting. On examination a 2.5 cm diameter non-inflamed, well circumscribed, firm mass—initially presumed to be a rheumatoid nodule or tense synovial cyst—was noted on the anteromedial aspect of the ankle joint. Ultrasonography (US) of the swelling showed a well circumscribed hypoechoic collection of homogeneous echo texture adjacent to the tibialis anterior tendon (fig 1). An 18 gauge needle was passed into the swelling under ultrasound guidance and 0.5 ml of thick caseous material was obtained. Polarised light microscopy demonstrated the presence of a large number of crystals between 10 and 100 µm in diameter, moderately positively birefringent in polarised light, with a characteristic squared shape of "stacked plates" with notched corners (fig . . . [Full text of this article]

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This article has been cited by other articles:

• Jansen, T. L. Th. A. (2006). Atorvastatine for chronic synovitis due to massive intra-articular cholesterol monohydrate deposition in long-standing rheumatoid arthritis. Rheumatology (Oxford) 45: 1577-1578 [Full Text]  

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