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The use of metamizol significantly increased in the last decade, especially in non US countries [1]. Although metamizol is known to be a non selective COX inhibitor and therefore has platelet inhibiting potential, it is widely used in pain management in postsurgical setting. Methods: We present a case of bleeding after microsurgical decompression of a narrow lumbar spinal canal. Our patient developed a bleeding complication 3 days after the surgery. The bleeding spontaneously resolved after stopping the application of metamizol. Metamizol is a non selective COX inhibitor and is used as standard analgetic drug after surgery in our department, whereas other COX inhibitors are not. We made an intensive literature research to evaluate the prohaemorrhagic potential of metamizol. Metamizol has proven dose dependent platelet inhibiting effect. Conclusions: This is a quite ordinary case and there is no proof of metamizol being responsible for the bleeding in this case, it still poses questions at our daily routine and the question about a dose dependent clinically relevant prohaemorrhagic effect of metamizol remains unanswered. A proper study is needed.

In the present understanding of joint pathology, the exact pathogenic role of hydroxyapatite crystals, both periarticularand intraarticular, is not yet completely clear. An association between rapidly destructive osteoarthritis (OA) andhydroxyapatite or basic calcium crystals was confirmed. This is a case report of a 78-year old female patient presentingwith a five-month history of shoulder pain with swelling of both AC joints. Imaging showed a large bursitis starting in theAC joints of both shoulders. Synovial fluid analysis showed many hydroxyapatite crystals and no calcium pyrophosphateor sodium urate crystals, which confirmed the diagnosis of crystal-induced periarthropathy and AC arthritis. Theseperiarticular radiographic and synovial fluid findings are a frequent and known manifestation of hydroxyapatite crystaldeposition disease, similar to the intra-articular destructive “Milwaukee shoulder syndrome”. Surgical intervention wasthe only therapeutic option to reduce the patient’s shoulder pain.