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[Coincident gout and bacterial infection]
Johannes W G Jacobs1, Franka van Reekum
1Universitair Medisch Centrum Utrecht, Afd. Reumatologie en Klinische Immunologie, Utrecht, the Netherlands. j.w.g.jacobs@umcutrecht.nl
Nederlands Tijdschrift Voor Geneeskunde
|October 28, 2010
Summary
Diagnosing joint inflammation requires careful consideration. Aspiration is crucial to differentiate gout from bacterial infection, especially in high-risk patients, guiding appropriate treatment for bursitis and gout.
Area of Science:
- Rheumatology
- Infectious Diseases
- Nephrology
Background:
- Tophaceous gout and chronic renal insufficiency secondary to systemic lupus erythematosus nephritis present complex comorbidities.
- Bursitis can mimic acute gout attacks, complicating initial diagnosis and treatment strategies.
Observation:
- A patient with known gout and lupus nephritis developed right lateral malleolus bursitis, initially treated as a gout flare.
- Lack of response to colchicine and increased glucocorticoids prompted diagnostic aspiration.
- Aspiration revealed Staphylococcus aureus and uric acid crystals, indicating a coexistent bacterial infection and gout.
Findings:
- The patient was diagnosed with both gout and a coincident bacterial infection (Staphylococcus aureus).
- Treatment involved incision and drainage of the bursa along with antibiotic therapy.
- The local condition resolved uneventfully following appropriate intervention.
Implications:
- Diagnostic aspiration is essential for patients at risk of bacterial infection presenting with suspected acute gout.
- Accurate differentiation between gout and bacterial infection is critical for effective management.
- Oral glucocorticoids should only be considered for gout flares after bacterial infection is definitively ruled out in patients with contraindications to NSAIDs and colchicine.
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