Chronic Multiple Gouty Arthritis Diagnosed during Anti-Tuberculosis Treatment of Recurrent Tuberculous Arthritis: A Case Report

Hyun Cheol Oh; Yoon Jung Choi; Joong Won Ha; Sang Hoon Park; Sang Hee Kim; Han Kook Yoon

doi:10.14193/jkfas.2018.22.3.116

Journal List > J Korean Foot Ankle Soc > v.22(3) > 1101130

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Oh, Choi, Ha, Park, Kim, and Yoon: Chronic Multiple Gouty Arthritis Diagnosed during Anti-Tuberculosis Treatment of Recurrent Tuberculous Arthritis: A Case Report

Case Report

J Korean Foot Ankle Soc 2018;22(3):116-119.

Published online: 20 January 2018

DOI: https://doi.org/10.14193/jkfas.2018.22.3.116

Chronic Multiple Gouty Arthritis Diagnosed during Anti-Tuberculosis Treatment of Recurrent Tuberculous Arthritis: A Case Report

Hyun Cheol Oh, Yoon Jung Choi, Joong Won Ha, Sang Hoon Park, Sang Hee Kim, Han Kook Yoon

Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea

^∗Departments of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Korea

^†Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea

Corresponding Author: Han Kook Yoon Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea Tel: 82-31-900-0540, Fax: 82-31-900-0343, E-mail: hangugy@nhimc.or.kr ORCID: https://orcid.org/0000-0002-8425-0693

Received 14 May 2018 Revised 3 August 2018 Accepted 13 August 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Gout occurs mainly in monoarthritis and is found in more than 50% of cases in hallux of the foot. In addition, symptoms sometimes begin in the hand, wrist, and elbow, but they are rarely observed in the spine. The patient was referred for tuberculous polyarthritis due to antituberculosis drug failure. Inflammatory findings were observed in the lumbar, elbow, wrist, hand and foot areas. Surgery was performed on the foot area and a pathology diagnosis revealed gouty arthritis. We report this case with a review of the relevant literature.

Keywords: Gout, Polyarthritis, Antituberculosis

References

1. Korean Foot and Ankle Society. The foot and ankle. Seoul: Jin;2010. p. 378–86.

2. Barret K, Miller ML, Wilson JT. Tophaceous gout of the spine mimicking epidural infection. Neurosurgery. 2001; 48:1170–2.

3. Rao TP, Shcmitt JK. Gout secondary to pyrazinamide and ethambutol. Va Med Q. 1996; 123:271.

4. Bădulescu M, Macovei L, Rezuş E. Acute gout attack with normal serum uric acid levels. Rev Med Chir Soc Med Nat Iasi. 2014; 118:942–5.

5. Suk KS, Kim KT, Lee SH, Park SW. Gout spondyloarthropathy in the lumbar spine mimicking pyogenic discitis: a case report. J Korean Orthop Assoc. 2006; 41:756–60.

6. Watts HG, Lifeso RM. Tuberculosis of bones and joints. J Bone Joint Surg Am. 1996; 78:288–98.

7. The Korean Orthopaedic Association. Tuberculosis of bone and joint. Suk SI, editor. Orthopaedics. 7th ed.Seoul: Choisin;2013. p. 356–8.

8. Malik A, Schumacher HR, Dinnella JE, Clayburne GM. Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. J Clin Rheumatol. 2009; 15:22–4.

9. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977; 20:895–900.

Figure 1.

Bone scan shows hot uptake at right elbow, wrist, hand, foot, and lumbar area (black arrows). IV: intravenous.

Figure 2.

(A) Gross photo shows swelling on right hallux. (B, C) Plain radiograph shows soft tissue swelling, bony erosion, osteopenia and mild subluxation on 1st metatarsal and phalanx.

Figure 3.

Sagittal T1 (A) fat suppression and T2 (B) weighted magnetic resonance imaging demonstrates a low to intermediate signal intensity mass around 1st metatarsophalangeal joint.

Figure 4.

Specimen shows chalky whitishy deposit.

Figure 5.

Amorphous tophaceous deposit surrounded by multinucleated giant cells and macrophage was noted (H&E stain, ×100).

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