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An unusual presentation of acute calcium pyrophosphate dihydrate arthropathy of the sternoclavicular joint in a patient with systemic lupus erythematosus.

This 75-year-old woman with a history of systemic lupus erythematosus presented with erythema, swelling, and pain at the right sternoclavicular joint as well as mild fever 1 day in duration. She denied any trauma, recent skin tears, wounds or insect bites, or intravenous drug abuse. Her previous medical history was remarkable for gout manifested as podagra (this was not proven as crystal), systemic lupus erythematosus, chronic obstructive pulmonary disease, spinal stenosis, avascular necrosis of the first metatarsal bone in her left foot occurring in the setting of sustained high corticosteroid dose, osteoporosis, sacral insufficiency fracture, and chronic lumbosacral pain. The right sternoclavicular joint was aspirated for a minimal amount of serosanguinous fluid (Fig. 1). Analysis of the fluid revealed a white blood cell count of 24.5 10/L with neutrophil value of 0.97. Results from an acid-