In our case study of a patient presenting with concomitant tophaceous gout and septic arthritis, we illustrate the management difficulty posed by this clinical scenario and postulate reasons for this. Concomitant septic and gouty arthritis an analysis of 30 cases. We postulate that biofilm may form on avascular gouty tophi. Given that all previous debridement and washouts were quickly followed by re-accumulation of infected tophaceous material in the knee, a decision was made to try an intermittent infusion of an antiseptic solution. National Center for Biotechnology Information , U.
Clinic symptoms may appear in patients who had untreated asymptomatic hyperuricemia for a long time. Gout is characterized by recurrent attacks of red, tender, hot, and swollen joints due to hyperuricemia that results from accelerated purine metabolism. Radiographic scans of the patient’s hands revealed bilateral juxta-articular osteopenia involving the metacarpophalangeal regions and bilateral symmetric radial and ulnar carpal joint space loss with associated erosive changes consistent with RA Figure 2. Written informed consent was obtained from the patient for publication of this case report and accompanying images in Journal of Medical Case Reports. He also denied any episode of swelling of great toe in the past. Gout can present with tophi as an initial manifestation of the disease process. Gout is a metabolic disease, which is characterized by acute or chronic arthritis, and deposition of monosodium urate crystals in joint, bones, soft tissues, and kidneys [ 1 – 4 ].
Following this no further tophaecous washouts were required. Another potent agent that may be utilized includes rasburicase. Radiographic scans of the patient’s hands revealed bilateral juxta-articular osteopenia involving the metacarpophalangeal regions and bilateral symmetric radial and ulnar carpal joint space loss with associated erosive changes consistent with RA Figure 2.
Table 2 Synovial fluid analysis. The patient sought treatment due to his inability to fully flex his right long finger.
Case Reports in Medicine
Every other day, wound care was done. Radiographs of both hands showed periarticular soft-tissue swelling and punched-out erosions with sclerotic margins in a marginal and juxta-articular distribution, with overhanging edges in interphalangeal joints typical for gouty arthritis.
The use of topical negative pressure therapy that targets kf has been well established for a range of wounds.
Post-operatively, active motion of the finger was encouraged and a prescription of allopurinol was given. All other medications were continued as previously described. Our patient tolerated anakinra injections well for months with no reported adverse events resulting in significant clinical improvement and serum uric acid in the target range.
Table 1 Laboratory values at admission. We opted to perform surgical exploration to remove the tophaveous using a longitudinal incision along the wrist flexion crease extending proximally.
A pilot study of IL-1 inhibition by anakinra in acute gout. This case report describes the use of this topical negative device with the instillation option in the management of severe septic arthritis with concomitant gout and suggests directions for further research. Novel biologic agents have been approved for use in such refractory cases.
This rapidly progressed to overt sepsis requiring admission to tsudy high dependency unit, six operative debridement and washouts and an extended course of broad spectrum intravenous antibiotics.
When considering the pathophysiology of resistant infections in an orthopaedic context, the issue of biofilm would be considered. Deposition of tophus is a common feature in chronic gout; however, signs and symptoms are not always well-pronounced in cases of uncommon sites.
[Full text] Atypical musculoskeletal manifestations of gout in hyperuricemia patie | OARRR
A diagnosis was made of left knee joint septic arthritis on a background of severe poliarticular tophaceous gout and immunocompromise secondary to regular prednisolone. Chronic gout and rheumatoid arthritis are common medical manifestations with debilitating effects on patients. Case presentation We present a year-old male patient who developed acute arthritis guot his hospital course.
This case of concomitant gout and septic arthritis did not appear to respond to conventional management of repeat washouts, debridement and broad spectrum IV antibiotics. Septic arthritis of the knee caused by antibiotic-resistant Acinetobacter baumannii in a gout pf a rare case report. Rasburicase represents a new tool for hyperuricemia in tumor lysis syndrome and in gout.
Bilateral Olecranon Tophaceous Gout Bursitis
He also denied any episode of swelling of great toe in the past. A year-old right-handed male presented in our outpatient clinic with inability to extend his right long finger since 1 month ago. Tophaceous gout may be presented with unusual clinical manifestations. N Engl J Med. Plain radiography of left elbow showed joint effusion, and soft tissue swelling. In summary, the patient presented with concomitant septic arthritis and severe poliarticular tophaeous gout affecting his knee.
The range of motion of the right long finger was excellent Figure 2.
Chronic tophaceous gout presenting as acute arthritis during an acute illness: a case report
Biofilms are surface-associated communities of bacteria surrounded in an extracellular matrix [ 18 ]. His long finger was held tophaceosu in the flexed position in an attempt to relieve the pain and numbness sensation.
Conventional radiography examination of the knee showed negative pathology except mild joint space narrowing.