Critical Cases - Concomitant Gout and Septic Arthritis!
Tue, 06/15/2021 - 9:33am
- 50 yo male with hx of gout on intermittent allopurinol, htn, CKD, and mechanical AVR on warfarin presents with one week of pain/swelling over the right third PIP joint
- There is no history of trauma
- Pt denies fevers
T 98.6 BP 157/98 HR 62 RR 16 Pox 97%
- Right hand third PIP joint marked edema, erythema, warmth, and tenderness to palpation
- Severe pain on ROM of joint
Plain Film Right Hand
- Soft tissue swelling and joint erosions at 3rd PIP joint
- The differential diagnosis for monoarticular inflammatory arthritis is narrow, principally gout/psuedogout versus infectious arthritis
- It is also possible for both gout and joint infection to co-exist!
- Arthrocentesis of the joint was performed with aspiration of 1 ml frankly purulent material
- Gram stain of aspirate was negative
- Fluid positive for monosodium urate crystals
- The aspirate was unable to be analyzed for cell count due to increased viscosity of fluid
- Hand surgery consulted who admitted patient for I&D and washout of the affected joint
- A septic joint can develop in a joint affected by gout, and patients are at increased risk for infection due to chronic damage to the joint
- The incidence of concomitant septic joint in patients with a gout flare is estimated to be 1.5-5%
- A monoarticular arthritis in patients with a history of gout cannot be assumed to be an acute gout flare alone!
- Definitive diagnosis requires a positive culture of synovial fluid aspirate
For further reading:
Panicker VN, Turner JK and Chehade MJ. Concomitant Septic Arthritis and Tophaceous Gout of the Knee Managed with Intermittent Closed Joint Irrigation Combined with Negative Pressure Therapy: A Case Study and Literature Review. Open Orthop J 2014; 8: 482-487.