A 50-year-old woman presented with a several-year history of acute and chronic joint pain. Her serum magnesium level was 0.9 mg per deciliter (0.4 mmol per liter) (normal range, 1.6 to 2.5 [0.7 to 1.0]), and the total daily urinary excretion of magnesium and the fractional clearance of magnesium were elevated. Radiography revealed chondrocalcinosis in the knee (Panel A, arrow), outlining the articular cartilage and especially the lateral meniscus, and calcifications in the wrist (Panel B) that were deposited on the triangular cartilage (arrow) as well as the radial-carpal and intercarpal cartilage. Chondrocalcinosis is the presence of linear, stippled calcification in joint cartilage. It is often found in association with pseudogout (calcium pyrophosphate–deposition disease). The knees and the wrists are the joints most frequently involved. Chronic hypomagnesemia secondary to the renal wasting of magnesium is uncommon but has been associated with chondrocalcinosis. This patient was treated with time-release magnesium salt tablets and antiinflammatory medication, with modest relief of joint pain.
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January 2009,
NEJM 2009,
NEJM 360
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