Journal of Bone and Mineral Metabolism

, Volume 30, Issue 6, pp 722–725

Adult hypophosphatasia with painful periarticular calcification treated with surgical resection

Authors

  • Kei-ichiro Iida
    • Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu University
    • Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu University
  • Toshifumi Fujiwara
    • Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu University
  • Yoshinao Oda
    • Department of Anatomic Pathology, Graduate School of Medical SciencesKyushu University
  • Yukihide Iwamoto
    • Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu University
Case Report

DOI: 10.1007/s00774-011-0338-9

Cite this article as:
Iida, K., Fukushi, J., Fujiwara, T. et al. J Bone Miner Metab (2012) 30: 722. doi:10.1007/s00774-011-0338-9

Abstract

Hypophosphatasia is a rare inherited disorder characterized by a low serum alkaline phosphatase (ALP) activity and defective bone mineralization. Adult hypophosphatasia typically manifests in middle-age as a result of osteomalacia with recurrent stress fractures of the lower limb. However, considerable variation occurs in the clinical expression of hypophosphatasia, and no curative treatment has yet been established. We herein report a case of adult hypophosphatasia with painful calcific periarthritis, which showed improvement after surgical resection. A 32-year-old male was referred to our clinic complaining of pain in his elbows and knees. A painful subcutaneous mass was palpable on his right lateral epicondyle, where periarticular calcification was detected by plain radiography. The laboratory data showed a slight decrease in serum ALP activity and bone mineral density, and an elevation in the urinary phosphoethanolamine. Genomic DNA sequencing revealed an F310L mutation and a Y246H polymorphism in the tissue-nonspecific alkaline phosphatase gene, confirming the diagnosis of hypophosphatasia. The pain in the patient’s right elbow was not responsive to nonsteroidal anti-inflammatory drugs, and triamcinolone diacetate was locally injected for treatment. His symptoms were ameliorated after the injection; however, they recurred in 3 months, and he became refractory to additional steroid injection. Surgical debridement of the calcified lesion was performed, and his symptoms were successfully ameliorated after the surgery.

Keywords

HypophosphatasiaAlkaline phosphataseCalcific periarthritisSurgical resection

Copyright information

© The Japanese Society for Bone and Mineral Research and Springer 2011