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Calcium pyrophosphate deposition (CPPD) in a liver transplant patient: are hypomagnesemia, tacrolimus or both guilty? A case-based literature review

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Abstract

Calcium pyrophosphate deposition (CPPD) can be induced by a persistent hypomagnesemia. Tacrolimus is an immunosuppressive treatment especially used in organ transplant, potentially inducer of hypomagnesemia by renal loss. A 53-year-old man, liver transplant 10 months earlier, developed an acute peripheral oligoarthritis of wrist, hip and elbow with fever, associated with acute low back pain. Synovial fluid was sterile, and revealed calcium pyrophosphate crystals. Spinal imaging showed inflammatory changes. Magnesium blood level was low at 0.51 mmol/l, with high fractional excretion in favor of renal loss. Tacrolimus was changed for everolimus, proton pump inhibitor was stopped, and magnesium oral supplementation was started. After 8 months follow-up and slow prednisone tapering, he did not relapse pain. Persistent hypomagnesemia is a rare secondary cause of CPPD. In this entity, drug liability should be investigated such as tacrolimus in organ transplant patient.

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Authors and Affiliations

  1. Department of Rheumatology, Rennes University Hospital, Rennes 1 University, 35000, Rennes, France

    Simon Cadiou, François Robin & Pascal Guggenbuhl

  2. Department of Hepato-Gastroenterology, Saint-Brieuc Hospital, 22000, Saint-Brieuc, France

    Antonia Le Gruyer

  3. Department of Hepato-Gastroenterology, Rennes Univsersity Hospital, Rennes 1 University, 35000, Rennes, France

    Baptiste Giguet

  4. Department of Rheumatology, Saint-Brieuc Hospital, 22000, Saint-Brieuc, France

    Morgane Milin, Xavier Guennoc & Marine De Saint-Riquier

  5. CHU Rennes, University of Rennes 1, INSERM, Institut NUMECAN (Nutrition Metabolisms and Cancer), UMR INSERM U 1241, 35000, Rennes, France

    Pascal Guggenbuhl

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  1. Simon Cadiou
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  4. François Robin
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Contributions

SC, for conception and design, acquisition and interpretation of data and drafting of manuscript. ALG, for case management and revising critically the manuscript. BG, for acquisition of data and revising critically the manuscript. FR, for design and drafting of systematic literature review and revising critically the manuscript. MM, for case management and revising critically the manuscript. XG, for conception and revising critically the manuscript. GP, for conception and design, drafting and revising critically the manuscript. MSR, for case management, conception and design, acquisition of data and revising the manuscript. All the authors approve this final version and agree to be accountable for all aspects of the work if questions arise related to its accuracy or integrity.

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Correspondence to Simon Cadiou.

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Cadiou, S., Le Gruyer, A., Giguet, B. et al. Calcium pyrophosphate deposition (CPPD) in a liver transplant patient: are hypomagnesemia, tacrolimus or both guilty? A case-based literature review. Rheumatol Int 42, 1105–1112 (2022). https://doi.org/10.1007/s00296-021-04828-0

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