No conflicts of interest to declare.
Gout, Have We Met before? No, Not Like This…
Article first published online: 22 AUG 2006
Journal of General Internal Medicine
Volume 21, Issue 12, pages C5–C7, December 2006
How to Cite
Mirzoyev, S. and Anavekar, N. (2006), Gout, Have We Met before? No, Not Like This…. Journal of General Internal Medicine, 21: C5–C7. doi: 10.1111/j.1525-1497.2006.00606.x
- Issue published online: 22 AUG 2006
- Article first published online: 22 AUG 2006
- Manuscript received January 7, 2006Initial editorial decision March 2, 2006Final acceptance July 3, 2006
- calf pain
LEARNING OBJECTIVES: Extra-articular symptoms could be the first manifestation of gouty arthritis (GA); polyarticular GA can mimic an infectious arthritis; infection can complicate GA.
CASE: A 66-year-old male with a history of gout presented with high fever and excruciating bilateral calf pain for 1 day. Examination revealed chronic knee effusions; range of motion in both knees was limited by calf pain. Joint aspiration showed negatively birefringent intracellular crystals and normal gram stain.
HOSPITAL COURSE: While receiving empiric antibiotics fever continued and he developed bilateral knee, right ankle, and shoulder pain. After demonstration of urate crystals and exclusion of infection, antibiotics were discontinued and steroids initiated. Fever, calf pain, and polyarthritis quickly resolved.
DISCUSSION: Polyarticular gouty attack is an uncommon presentation of gout, and can mimic several other conditions. An exceptional presentation of this entity is excruciating calf pain, probably caused by tenosynovitis or referred pain preceding an acute polyarticular gouty attack.