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23 November 2021 : Case report  Germany

[In Press] A Rare Cause of Left Shoulder Pain in a Peritoneal Dialysis Patient

Unknown etiology, Challenging differential diagnosis, Patient complains / malpractice, Rare disease, Rare coexistence of disease or pathology

Frank-Peter Tillmann1ABEF, Ana Harth1EF, Achim Jörres1EF

DOI: 10.12659/AJCR.933223

Am J Case Rep In Press; DOI: 10.12659/AJCR.933223  

Available online: 2021-11-23, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Non-specific pain of connective tissues and joints is one of the most frequently expressed patient concerns in everyday practice. The most common cause is osteo-degenerative changes in the cartilage and/or joint system. Metastatic calcification is a rare and initially often overlooked cause of persistent, therapy-resistant pain of connective tissues and joint apparatus in end-stage renal disease (ESRD) patients on dialysis therapy. These calcifications are induced by persistent hyperphosphatemia/hyperparathyroidism and can occur in various organs, including joints, tendons, heart valves, soft tissues, and blood vessels.
We report on a 46-year-old male patient with ESRD due to cANCA-associated systemic vasculitis. The patient evolved unfavorably to end-stage renal failure and started continuous ambulatory peritoneal dialysis (CAPD). Four years after initiation of CAPD, the patient reported having painful motion of the left shoulder, and symptomatic physiotherapy and non-steroidal-anti-inflammatory-drugs (NSAIDs) were prescribed. An X-ray examination of the left shoulder showed severe periarticular calcifications. Repeated nutritional counselling was offered, and intensive phosphate-binder therapy was administered, resulting in a reduction in phosphate levels from 2.10 mmol at the time of diagnosis to 1.26 mmol/l 16 months later. Radiological reevaluation showed a near complete resolution of the periarticular calcifications.
Metastatic calcifications may arise in ESRD patients despite only moderately elevated blood phosphate levels. Intensive measures to reduce the phosphate load to normal levels should be implemented and can lead to almost complete resolution of ectopic calcifications in affected patients.

Keywords: Calcification of Joints and Arteries; Dialysis; Hyperphosphatemia; Peritoneal Dialysis, Continuous Ambulatory; Shoulder Dystocia; Shoulder Pain


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Am J Case Rep In Press; DOI: 10.12659/AJCR.934399  

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19 Jan 2022 : Case report  Latvia

Rare Case of Hodgkin Lymphoma Transformation into Diffuse Large B-Cell Lymphoma with Atypical Spread Epidur...

Am J Case Rep In Press; DOI: 10.12659/AJCR.935014  

19 Jan 2022 : Case report  Saudi Arabia

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Am J Case Rep In Press; DOI: 10.12659/AJCR.935393  

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Am J Case Rep In Press; DOI: 10.12659/AJCR.935250  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923