Greater Trochanteric Pain Syndrome Due to Tumoral Calcinosis in a Patient with Chronic Kidney Disease

Tumoral calcinosis is a rare syndrome characterized by massive subcutaneous soft tissuedeposits of calcium phosphate near the large joints. It is more prevalent in patients withchronic kidney disease undergoing dialysis.A 57-year-old woman was referred to our pain clinic with the complaint of severe painin the left buttock and lateral hip. The patient had been suffering from chronic kidneydisease for 10 years and had been undergoing peritoneal dialysis over the past 5 years.The patient’s symptom was initially suspected to be of lumbar origin at the L5 leveland a left L5 transforaminal epidural block was performed, but without success. Reevaluation of the physical examination revealed severe tenderness over the left greatertrochanter and piriformis muscle. On ultrasonographic evaluation, multiple mass-likelesions in the left buttock were observed. About 30 mL of fluid was aspirated from thecystic lesions, followed by 30 mL mixture of 0.08% levobupivacaine and triamcinolone40 mg injected into the bursa under ultrasound guidance, which brought pain relief.Trochanteric bursitis was thought of as the cause of the symptoms. The patient wasdiagnosed with tumoral calcinosis based on the past medical history, simple plainradiographs, and hip magnetic resonance imaging (MRI).We diagnosed a case of greater trochanteric pain syndrome due to tumoral calcinosisrelated to chronic kidney disease in a patient whose symptoms had initially beenconsidered to be radiating leg pain caused by lumbar spinal disease. We report ourexperience of symptomatic improvement following the repeated ultrasound-guidedaspiration of calcific fluid and the injection of a mixture of local anesthetic and steroid.Key words: Trochanteric bursitis, greater trochanteric pain syndrome, tumoralcalcinosis