Masashi OHE

A Case of Pseudogout Successfully Treated with Prednisolone and Clarithromycin

To the Editor pseudogout (PG) is an acute arthritis induced by calcium pyrophosphate dihydrate crystal deposition, and it frequently develops in the elderly population. Non-steroidal anti-inflammatory drugs and/or corticosteroids, such as prednisolone (PSL), administered either by local intra-articular injection or systemic therapy remain the mainstay of PG treatment.1 Macrolide antibiotics (MACs), such as clarithromycin (CAM) and azithromycin (AZM) provide not only antibacterial activity but also anti-inflammatory properties. Several recent studies reported the successful treatment of rheumatoid arthritis2 and polymyalgia rheumatica3 using CAM as an anti-inflammatory agent. Herein, we describe a case of PG treated with PSL in combination with CAM, considering their anti-inflammatory properties. A 92-year-old female with Alzheimer’s disease, hypertension and osteoporosis presenting with fever, arthralgia and articular swellings in her bilateral shoulders, elbows, and wrists, was referred to our hospital. At the age of 91, she was diagnosed with PG by an orthopedic doctor. So far, she has experienced two PG attacks. The laboratory findings on this visit were as follows: white blood cell count, 8,990/μL (basophils, 0.3%; eosinophils, 1.0%; neutrophils, 78.4%; lymphocytes, 12.7%; and monocytes, 7.6%); C-reactive protein (CRP), 11.81 mg/dL; rheumatoid factor, 5 IU/L; anti-cyclic citrullinated peptide antibody, 0.5 U/mL; and antinuclear antibody titer, 1:40. A blood culture yielded negative results. No abnormal findings suggestive of infection could be found in the systemic survey, including the chest roentgenogram and urinalysis. Bone roentgenogram revealed intra-articular calcification compatible with PG. The aforementioned symptoms were similar to those of the previous PG attacks; therefore, the patient was diagnosed with PG attack. Initially, she was treated with acetaminophen (800 mg/day), which was unsuccessful, although it was effective in the previous PG attacks. Therefore, she was treated with PSL (10 mg/day). Seven days after PSL treatment, fever and articular symptoms rapidly improved with a decreased CRP of 1.12 mg/dL. Therefore, the PSL dosage was decreased to 7.5 mg/day. A week later, fever and articular symptoms relapsed with an

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