Evaluation of a case pseudogout with diabetes and cardiomegaly

A 43-year-old man with diabetes and cardiomegaly has had an attack of pseudogout. He should be evaluated for which of the following?

• a.Renal disease
• b.Hemochromatosis
• c.Peptic ulcer disease
• d.Lyme disease
• e.Inflammatory bowel disease

The answer is b.

Calcium Pyrophosphate Crystals

Pseudogout is part of the spectrum of calcium pyrophosphate deposition disease. It is usually an acute monoarthritis or oligoarthritis caused by calcium pyrophosphate crystals in the joint. Pseudogout may be associated with hemochromatosis. Since the patient has a history of diabetes mellitus and cardiomyopathy, hemochromatosis must be considered. Serum iron saturation should be measured. Ferritin may also be a useful measure of iron stores. Pseudogout has also been associated with hyperparathyroidism. A familial form of the disease has been localized to chromosomes 8q and 5p. Inflammatory bowel disease, Lyme disease, and peptic ulcer disease do not predispose to pseudogout.