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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Atraumatic Toe Pain: Acute Calcific Periarthritis.

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Acute calcific periarthritis (ACP) is a common yet overlooked condition mimicking joint infections. Early recognition of hydroxyapatite crystal deposition is key to accurate diagnosis and avoiding unnecessary treatments.

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Area of Science:

  • Rheumatology
  • Orthopedics
  • Radiology

Background:

  • Acute calcific periarthritis (ACP) is a self-limiting condition often misdiagnosed due to its mimicry of severe joint pathologies like septic arthritis.
  • ACP involves hydroxyapatite crystal deposition in periarticular tissues, commonly affecting the shoulder but also other joints including the feet.

Observation:

  • A 43-year-old woman presented with acute right second toe pain and swelling post-run.
  • Initial emergency department evaluation with ultrasound and C-arm imaging showed periarticular calcification, but ACP was not diagnosed.
  • Diagnosis was delayed by two months, highlighting challenges in recognizing ACP.

Findings:

  • ACP presents as acute monoarticular pain, swelling, erythema, and limited motion, overlapping with crystal arthropathies, infection, and injury.
  • Radiographs and ultrasound are crucial for identifying calcifications and excluding other causes.
  • This case underscores the diagnostic utility of imaging in identifying ACP.

Implications:

  • Timely recognition of ACP in emergency settings is vital to prevent unnecessary interventions, consultations, and diagnostic delays.
  • Including ACP in the differential diagnosis for acute monoarticular joint pain improves patient management.
  • This case emphasizes the importance of considering ACP in acute joint pain presentations.