title: Chronic calcium pyrophosphate crystal inflammatory arthritis induced by extreme hypomagnesemia in short bowel syndrome.
abstract: BACKGROUND
  Short bowel syndrome (SBS) may induce a plethora of clinical symptoms ranging from underweight to nutrient-, vitamin- and electrolyte deficiencies. The objective of this case report is to illustrate how demanding the management of a 60 year old patient with SBS and recurrent joint attacks was for different medical disciplines.
  
  
  METHODS
  The patient with SBS presented with a body mass index of 16.5 kg/m2 after partial jejunoileal resection of the small intestine with a six year long history of recurrent pain attacks in multiple peripheral joints, chronic diarrhoea and food intolerances. Pain attacks occurred 4-5 times a week with a median consumption of 15 mg prednisone per day. The interdisciplinary workup after several gastroenterologic, rheumatologic, radiologic, psychiatric and orthopedic consultations is shown including successful treatment steps.Clinical diagnosis revealed no systemic inflammatory disease, but confirmed extreme hypomagnesemia (0.2 mmol/l) after reproducible pathological magnesium resorption tests as causative for chronic calcium pyrophosphate crystal inflammatory arthritis (pseudogout, chondrocalcinosis).Multidisciplinary treatment included application of colchicines, parenteral nutrition and magnesium substitution, antiperistaltic agents and avoidance of intolerant foods. Normalization of magnesium levels and a marked remission of joint attacks were achieved after six months with significant reduction of prednisone to 1.5 mg/day.
  
  
  CONCLUSIONS
  Despite the rarity of this condition, it is important to know that hypomagnesaemia may be associated with calcium pyrophosphate crystal inflammatory arthritis (chondrocalcinosis) and that SBS patients may be prone to develop extreme hypomagnesaemia causing recurrent joint attacks without systemic inflammation.
authors.affiliation: Department of Medicine I, Gastroenterology, University Erlangen-Nürnberg, Ulmenweg 18, Erlangen 91054, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Hahn
authors.forename: Martin
authors.initials: M
authors.lastname: Raithel
authors.forename: Alexander
authors.initials: A
authors.lastname: Hagel
authors.forename: Teresa
authors.initials: T
authors.lastname: Biermann
authors.forename: Bernhard
authors.initials: B
authors.lastname: Manger
mesh_terms: D018771:Arthralgia / Q000209:etiology; D001168:Arthritis / Q000209:etiology* / Q000378:metabolism / Q000628:therapy; D002131:Calcium Pyrophosphate / Q000378:metabolism*; D006801:Humans; D008274:Magnesium / Q000097:blood; D008275:Magnesium Deficiency / Q000097:blood / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012778:Short Bowel Syndrome / Q000097:blood / Q000150:complications* / Q000628:therapy
chemical_list: D008274:Magnesium; D002131:Calcium Pyrophosphate