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Gouty Arthritis of the Spine in a Renal Transplant Patient: A Clinical Case Report: An Unusual Presentation of a Common Disorder
Axial gout is a well-documented but uncommon manifestation of gout. Its mimicking nature and the impracticality of axial joint aspiration might considerably delay its diagnosis. We report a case in a normouricemic renal transplant recipient, whereby the primary symptom of severe neck pain suggested...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554016/ https://www.ncbi.nlm.nih.gov/pubmed/25837758 http://dx.doi.org/10.1097/MD.0000000000000676 |
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author | Dhaese, Sofie Stryckers, Marijke Van Der Meersch, Hans Terryn, Wim Van Laecke, Steven |
author_facet | Dhaese, Sofie Stryckers, Marijke Van Der Meersch, Hans Terryn, Wim Van Laecke, Steven |
author_sort | Dhaese, Sofie |
collection | PubMed |
description | Axial gout is a well-documented but uncommon manifestation of gout. Its mimicking nature and the impracticality of axial joint aspiration might considerably delay its diagnosis. We report a case in a normouricemic renal transplant recipient, whereby the primary symptom of severe neck pain suggested pyogenic spondylodiscitis as an initial tentative diagnosis. Clinical findings included a high C-reactive protein concentration and elevated body temperature. The patient did not respond to empiric antibiotic treatment and suffered consecutive attacks of severe wrist and ankle pain in conjunction with a persistent fever. Blood and joint cultures were negative, but analysis of aspirated ankle joint fluid revealed monosodium urate crystals. A dual-energy computed tomography scan confirmed the presence of monosodium urate crystals in the costovertebral joints. Colchicine treatment dramatically improved the patient's clinical condition. Axial gout should be considered in transplant recipients with severe neck or back pain, fever, and increased inflammatory parameters with a high likelihood of an infectious etiology, despite the presence of paradoxically normal or even decreased serum urate concentrations. Dual-energy computed tomography is a noninvasive technique of possible benefit in the detection of axial gout when joint fluid aspiration is not deemed safe. |
format | Online Article Text |
id | pubmed-4554016 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-45540162015-10-27 Gouty Arthritis of the Spine in a Renal Transplant Patient: A Clinical Case Report: An Unusual Presentation of a Common Disorder Dhaese, Sofie Stryckers, Marijke Van Der Meersch, Hans Terryn, Wim Van Laecke, Steven Medicine (Baltimore) 6900 Axial gout is a well-documented but uncommon manifestation of gout. Its mimicking nature and the impracticality of axial joint aspiration might considerably delay its diagnosis. We report a case in a normouricemic renal transplant recipient, whereby the primary symptom of severe neck pain suggested pyogenic spondylodiscitis as an initial tentative diagnosis. Clinical findings included a high C-reactive protein concentration and elevated body temperature. The patient did not respond to empiric antibiotic treatment and suffered consecutive attacks of severe wrist and ankle pain in conjunction with a persistent fever. Blood and joint cultures were negative, but analysis of aspirated ankle joint fluid revealed monosodium urate crystals. A dual-energy computed tomography scan confirmed the presence of monosodium urate crystals in the costovertebral joints. Colchicine treatment dramatically improved the patient's clinical condition. Axial gout should be considered in transplant recipients with severe neck or back pain, fever, and increased inflammatory parameters with a high likelihood of an infectious etiology, despite the presence of paradoxically normal or even decreased serum urate concentrations. Dual-energy computed tomography is a noninvasive technique of possible benefit in the detection of axial gout when joint fluid aspiration is not deemed safe. Wolters Kluwer Health 2015-04-03 /pmc/articles/PMC4554016/ /pubmed/25837758 http://dx.doi.org/10.1097/MD.0000000000000676 Text en Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0 |
spellingShingle | 6900 Dhaese, Sofie Stryckers, Marijke Van Der Meersch, Hans Terryn, Wim Van Laecke, Steven Gouty Arthritis of the Spine in a Renal Transplant Patient: A Clinical Case Report: An Unusual Presentation of a Common Disorder |
title | Gouty Arthritis of the Spine in a Renal Transplant Patient: A Clinical Case Report: An Unusual Presentation of a Common Disorder |
title_full | Gouty Arthritis of the Spine in a Renal Transplant Patient: A Clinical Case Report: An Unusual Presentation of a Common Disorder |
title_fullStr | Gouty Arthritis of the Spine in a Renal Transplant Patient: A Clinical Case Report: An Unusual Presentation of a Common Disorder |
title_full_unstemmed | Gouty Arthritis of the Spine in a Renal Transplant Patient: A Clinical Case Report: An Unusual Presentation of a Common Disorder |
title_short | Gouty Arthritis of the Spine in a Renal Transplant Patient: A Clinical Case Report: An Unusual Presentation of a Common Disorder |
title_sort | gouty arthritis of the spine in a renal transplant patient: a clinical case report: an unusual presentation of a common disorder |
topic | 6900 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554016/ https://www.ncbi.nlm.nih.gov/pubmed/25837758 http://dx.doi.org/10.1097/MD.0000000000000676 |
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