Case Report
Volume 2 Issue 2 - 2020
Ochronosis of Achillis Tendon Enthesopathy- Rare Case
Anil Neerukonda Hospital, NRI Institute of Medical Sciences, Sangivalasa. Visakapatnam, India
*Corresponding Author: Siddaram Patil, Professor & HOD, Anil Neerukonda Hospital, NRI Institute of Medical Sciences, Sangivalasa. Visakapatnam, India.
Received: October 19, 2020; Published: October 28, 2020
Case History
A 43 year old male patient presended with pain on left tendoachillis region, with swelling and difficulty in walking .unable to planter flex ion of 15 days duration .History of sudden jerk when trying to get up from chair and heard a snap, followed by pain which lasted for 10 days
On clinical examination: weakness in limb, difficulty in walking and driving car. Recent past he had similar complain on other leg, but improved by conservative treatment.
Swelling, step sign, positive Thompsons test ,unable to activly dorsiflex the ankle joint , pain sub sided by medication, Routine investigation where normal , ultra sound showed tear in Tendo-Achillis tendon, Planned for Tendon repair surgically.
On questioning the patient admitted that his urine was dark on standing and his mother having brown pigmented patch on both cheeks and blackening of urine on standing. Urinary chromatography showed elevated levels of homogenitisic acid.there is history of consanginous marriage of their parents.
Intra-operative findings – Black colour crystals were found in and around the tendo-achillis
Figure 1 and 2:
Histopathology
Gross: Multiple grey brown to grey tan ,gritty bits ,all togather measuring 3 cms by 2 cms.
Microscopy: cartilage and dense fibrous tissue fragments with locally scatered deposits (Figures 1,2) of pale amber –coloured pigment intermingled with in collegen fibers.At foci the pigment is broken into crystalline fragments with pointed ends.(Figures 4,5).
H&Estaining:Focal ares of dystrofic calcification and congested blood vessels with scanty inflammatory cell collections are also noted. Figures 5.6 )
Figure 3: 10X, H&E staining.
Figure 4: 10X, H&E staining.
Figure 5: 10X, H&E staining.
Figure 6: 10X, H&E staining.
Dignosis
Featurs are consistant with OCHRONOSIS OF TENDO- ACHILLIS ENTHESOPATHY
Featurs are consistant with OCHRONOSIS OF TENDO- ACHILLIS ENTHESOPATHY
Discussion
Ochronosis is a rare metabolic disease, autosomal disorder caused by defect in tyrosine metabolism due to congenital abscenc of homogentisic acid oxidase present on chromosome 4q23 with a prevalnce of about 1:1,000,000.Spontaneous tendon ruture are common in these patients with tendoachillis rupture as a clinical menifestation. When middle aged patients present with chrinic bach ache and enthesopathy, one should keep in mind the possibility of ochronosis, which can be confirmede by urine chromatography for homogentisic acid, active survilance for cardiac, renal and prostate complications should be done after the 4th decade of life.
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Citation: Dr Asha Lata Jr, Dr Azeez Q and Dr S N Patil. (2020). Ochronosis of Achillis Tendon Enthesopathy- Rare Case. Journal of Orthopaedic and Trauma Care 2(2).
Copyright: © 2020 Siddaram Patil. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.