An unusual case of acute pseudogout in the hand masquerading as cellulitis - Clinical Case Report

Sep 30, 2026

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Calcium pyrophosphate deposition disease often affects the wrist yet is frequently underreported, leading to diagnostic errors when symptoms are nonspecific. This case describes an elderly woman with an acutely swollen, warm hand whose presentation mimicked cellulitis and initially received antibiotics without improvement. Multiple intra-articular calcifications supported a final diagnosis of acute chondrocalcinosis. After glucocorticoid treatment, symptoms improved and inflammation markers dropped substantially. The report highlights early accurate recognition to avoid unnecessary antibiotic use.

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Introduction

Case report

® Clinical Case Report An unusual case of acute pseudogout in the hand masquerading as cellulitis Yake Meng, MDa ,* , Lili Zhou, MDb , Rongxue Shao, MDa , Wei Zhag, MDa , Hao Pan, MDa | Abstract
Rationale: The wrist joint represents one of the most commonly affected anatomical sites in calcium pyrophosphate deposition disease, yet it remains underreported in the literature, frequently leading to diagnostic errors.
Patient concerns: We present a case of acute pseudogout of the wrist whose symptoms mimicked cellulitis. Our patient presented with a swollen hand, which was initially treated as acute cellulitis with antibiotics, but without any improvement. Diagnoses: A final diagnosis of acute chondrocalcinosis was made based on multiple intra-articular calcifications. Outcomes: The patient’s symptoms were significantly relieved, and her inflammation markers were markedly reduced after glucocorticoid administration.
Lessons: Pseudogout of the wrist can present with a pseudocellulitis appearance in the acute phase. Early accurate diagnosis can help physicians provide adequate treatment and avoid unnecessary antibiotic use.
Abbreviations: CPP = calcium pyrophosphate crystals, CPPD = calcium pyrophosphate deposition disease, CT = computed tomography, MCP = metacarpophalangeal, SF = synovial fluid. | | --- | | Keywords: calcium pyrophosphate deposition, cellulitis, hand, pseudogout | 1. Introduction Calcium pyrophosphate dihydrate deposition disease is oneof the most common types of inflammatory arthritis, primarily affecting the elderly. The prevalence of calcium pyrophosphate deposition disease (CPPD) increases with age, rising from approximately 15% in individuals over 60 to nearly 30% in those over 80.[1] The knee was the most commonly involved joint in CPPD, followed by the wrist. The small joints of the hands can also be affected; however, the relevant literature on this presentation is scarce. The clinical manifestations of CPPD disease span a broad spectrum, from asymptomatic presentation to severe, destructive polyarticular arthritis.[2] This nonspecific clinical picture frequently complicates accurate diagnosis. We herein report a case of acute pseudogout affecting the hand in an elderly woman, which was initially misdiagnosed as cellulitis. 2. Case report In March 2024, a 71-year-old woman presented with an erythematous, warm, and swollen left hand for the past 3 days. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. The authors have no funding and conflicts of interest to disclose. The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request. The need for ethics approval is not subject to the institutional review board (local ethics committee) due to simple case reporting. Written informed consent was obtained from the patient to report and publish individual patient data. a Department of Orthopedics, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China, b Department of Neurology, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China. The patient denied a recent history of hand trauma. She suffered from a history of unexplained left forearm and hand swelling 2 years ago. Prior diagnosis and treatment details were unknown. She had a significant medical history that included diabetes, high blood pressure, and osteoarthritis of the knees. She was currently taking metformin and amlodipine. There was no family history of gout. The clinical examination revealed severe diffuse swelling, redness, and tenderness of the left hand, and the range of motion of the hand joints was markedly decreased. Her peripheral pulse

FAQs

Why was the patient initially diagnosed with cellulitis?

The patient presented with an erythematous, warm, and swollen hand and had elevated inflammatory markers, which led clinicians to treat it as hand cellulitis with intravenous antibiotics.

How was acute pseudogout (acute chondrocalcinosis) ultimately diagnosed?

A final diagnosis of acute chondrocalcinosis was made based on multiple intra-articular calcifications, supported by further evaluation.

What treatment led to symptom improvement and what was the outcome?

Glucocorticoid administration significantly relieved symptoms and markedly reduced inflammation markers after antibiotics failed to improve the patient’s condition.

Sep 30, 2026

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