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Gouty tenosynovitis with compartment syndrome in the hand: A case report

BACKGROUND: Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues. It typically appears with abrupt and intense pain, redness, and swelling in the affected joint. It frequently targets the lower extremities, such a...

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Autores principales: Lee, Dong Yun, Eo, SuRak, Lim, SooA, Yoon, Jung Soo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10643075/
https://www.ncbi.nlm.nih.gov/pubmed/37969458
http://dx.doi.org/10.12998/wjcc.v11.i30.7492
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author Lee, Dong Yun
Eo, SuRak
Lim, SooA
Yoon, Jung Soo
author_facet Lee, Dong Yun
Eo, SuRak
Lim, SooA
Yoon, Jung Soo
author_sort Lee, Dong Yun
collection PubMed
description BACKGROUND: Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues. It typically appears with abrupt and intense pain, redness, and swelling in the affected joint. It frequently targets the lower extremities, such as the big toe. However, rarely, gout can manifest in atypical locations, including the hands, leading to an uncommon presentation known as gouty tenosynovitis. However, it can result in significant morbidity owing to the potential for severe complications, such as myonecrosis and compartment syndrome. CASE SUMMARY: An 82-year-old male patient with a history of hypertension, cerebral infarction, Parkinson's disease, and recurrent gout attacks sought medical attention because of progressive pain and swelling in the right hand. Imaging findings revealed forearm swelling, raising concerns of possible tenosynovitis, bursitis, septic arthritis, and compartment syndrome. A fasciotomy was performed to decompress the patient’s hands and forearms. The procedure revealed diffuse tenosynovitis, tophi with a pus-like discharge surrounding the carpal tunnel, and involvement of the flexor and extensor tendon sheaths. However, microbiological investigations, including Gram staining, acid-fast bacilli, tuberculosis, and non-tuberculous mycobacteria, yielded negative results. The patient was ultimately diagnosed with a severe gouty attack with compartment syndrome and myonecrosis. Septic arthritis and infectious flexor tenosynovitis were ruled out. Serial debridement and inflammation control were initiated, followed by staged closure with a skin graft. CONCLUSION: Septic-like complications can occur in the absence of infection in severe gout attacks with pus-like discharges due to compartment syndrome and myonecrosis. Cultures can be used to differentiate between gouty attacks, septic arthritis, and infectious tenosynovitis. Involvement of the flexor and extensor muscles, as in this case, is rare. This study contributes to the literature by reporting a rare case of successful fasciotomy and serial debridement in an elderly patient with multiple comorbidities.
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spelling pubmed-106430752023-11-15 Gouty tenosynovitis with compartment syndrome in the hand: A case report Lee, Dong Yun Eo, SuRak Lim, SooA Yoon, Jung Soo World J Clin Cases Case Report BACKGROUND: Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues. It typically appears with abrupt and intense pain, redness, and swelling in the affected joint. It frequently targets the lower extremities, such as the big toe. However, rarely, gout can manifest in atypical locations, including the hands, leading to an uncommon presentation known as gouty tenosynovitis. However, it can result in significant morbidity owing to the potential for severe complications, such as myonecrosis and compartment syndrome. CASE SUMMARY: An 82-year-old male patient with a history of hypertension, cerebral infarction, Parkinson's disease, and recurrent gout attacks sought medical attention because of progressive pain and swelling in the right hand. Imaging findings revealed forearm swelling, raising concerns of possible tenosynovitis, bursitis, septic arthritis, and compartment syndrome. A fasciotomy was performed to decompress the patient’s hands and forearms. The procedure revealed diffuse tenosynovitis, tophi with a pus-like discharge surrounding the carpal tunnel, and involvement of the flexor and extensor tendon sheaths. However, microbiological investigations, including Gram staining, acid-fast bacilli, tuberculosis, and non-tuberculous mycobacteria, yielded negative results. The patient was ultimately diagnosed with a severe gouty attack with compartment syndrome and myonecrosis. Septic arthritis and infectious flexor tenosynovitis were ruled out. Serial debridement and inflammation control were initiated, followed by staged closure with a skin graft. CONCLUSION: Septic-like complications can occur in the absence of infection in severe gout attacks with pus-like discharges due to compartment syndrome and myonecrosis. Cultures can be used to differentiate between gouty attacks, septic arthritis, and infectious tenosynovitis. Involvement of the flexor and extensor muscles, as in this case, is rare. This study contributes to the literature by reporting a rare case of successful fasciotomy and serial debridement in an elderly patient with multiple comorbidities. Baishideng Publishing Group Inc 2023-10-26 2023-10-26 /pmc/articles/PMC10643075/ /pubmed/37969458 http://dx.doi.org/10.12998/wjcc.v11.i30.7492 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Case Report
Lee, Dong Yun
Eo, SuRak
Lim, SooA
Yoon, Jung Soo
Gouty tenosynovitis with compartment syndrome in the hand: A case report
title Gouty tenosynovitis with compartment syndrome in the hand: A case report
title_full Gouty tenosynovitis with compartment syndrome in the hand: A case report
title_fullStr Gouty tenosynovitis with compartment syndrome in the hand: A case report
title_full_unstemmed Gouty tenosynovitis with compartment syndrome in the hand: A case report
title_short Gouty tenosynovitis with compartment syndrome in the hand: A case report
title_sort gouty tenosynovitis with compartment syndrome in the hand: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10643075/
https://www.ncbi.nlm.nih.gov/pubmed/37969458
http://dx.doi.org/10.12998/wjcc.v11.i30.7492
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