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Images in Rheumatology

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Arthritis Induced by Corticosteroid Crystals

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ENRICO SELVI, MD; RENATO De STEFANO, MD; SAURO LORENZINI, BSc; ROBERTO MARCOLONGO, Professor, Section of Rheumatology,
Department of Clinical Medicine and Immunological Science, University of Siena, Viale Bracci, I-53100 Siena, Italy. Address reprint requests to Dr. Selvi.

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E-mail: eselvi@katamail.com

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A 65-year-old man with bilateral osteoarthritis of the knee corticosteroid (Figure 1B). He underwent joint lavage with

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presented a joint effusion of the left knee. The swollen joint 1 l of normal saline and recovered completely within one
was treated with a 40 mg intraarticular injection of triamci- day. The conclusive diagnosis was triamcinolone hexace-

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nolone hexacetonide. The next day, he presented with acute tonide crystal-induced arthritis1,2.

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arthritis in the injected knee; the joint was swollen and

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tender and he was unable to walk. Septic arthritis was REFERENCES
considered and the joint fluid was aspirated. Gross exami- 1. Schumacher HR, Reginato AJ. Synthetic depot corticosteroid

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crystals. In: Schumacher HR, Reginato AJ. Atlas of synovial fluid
nation showed 35 ml of a thick, turbid, yellowish synovial
analysis and crystal identification. Philadelphia: Lea & Febiger;

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fluid (Figure 1A). Leukocyte count was 13,000 cells/mm3 1991:183-7.
with 95% neutrophils. Gram and acridine orange stainings 2. McCarty DJ, Hogan JM. Inflammatory reaction after intra-synovial

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were negative. Wet preparations of the specimen with polar- injection of microcrystalline adreno-corticosteroid esters. Arthritis

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izing compensated microscopy showed numerous birefrin- Rheum 1964;7:359-61.
gent, pleomorphic intra- and extracellular crystals of the
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Figure 1. A. Macroscopic appearance of the synovial fluid aspirated from the left knee. B.
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Intracellular triamcinolone hexacetonide crystals. Compensated polarized light, ×100.

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Personal, non-commercial use only. The Journal of Rheumatology Copyright © 2004. All rights reserved.
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622 The Journal of Rheumatology 2004; 31:3

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