Beyond Painful Bones and Renal Stones: Acute Crystal Arthropathy of Dual Aetiology May Be an Unforeseen Complication Following Parathyroid Surgery

Primary hyperparathyroidism (PHPT), one of the most common endocrine conditions, has myriad manifestations, including nephrolithiasis, osteoporosis, neuropsychiatric complications and fatigue. The treatment of choice is focused parathyroidectomy when the lesion is localised. Common complications following parathyroidectomy include hypoparathyroidism and hungry bone syndrome. Acute crystal arthropathy due to gout and pseudogout following parathyroid surgery is scarcely reported. We report the case of a 47-year-old man who developed painful swelling of bilateral ankle joints following parathyroidectomy for PHPT. Synovial fluid aspirate from the ankle joint showed positively birefringent rhomboid-shaped calcium pyrophosphate dihydrate (CPPD) crystal and needle-shaped crystal of mono-sodium urate on polarised light microscopy. He was initiated on analgesics and glucocorticoids and had symptomatic improvement. The development of acute painful swelling of the joints following parathyroidectomy should alert the clinician to the possibility of gout and pseudogout; the timely recognition and treatment will aid in quick recovery.