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Runner with gout and an aortic valve nodule
1University of Pittsburgh, Division of Cardiology, PA 15213, USA.
Insights
Endurance athletes drinking beer are at risk for acute gout, which can mimic endocarditis. Misdiagnosed gout may lead to joint and visceral tophi, highlighting the importance of accurate diagnosis in athletes.
Area of Science:
- Rheumatology
- Cardiology
- Sports Medicine
Background:
- Endurance athletes may face unique health risks.
- Gout (a form of inflammatory arthritis) can affect joints.
- Infectious endocarditis is a serious heart valve infection.
Observation:
- A male endurance athlete developed acute knee and ankle pain after running and drinking beer.
- He was initially suspected of having endocarditis due to a heart murmur and aortic valve nodule.
- Synovial fluid analysis revealed acute gout, leading to rapid improvement with anti-gout therapy.
Findings:
- Acute gout can present with symptoms mimicking infectious endocarditis.
- Undiagnosed or undertreated gout can progress to polyarticular disease and visceral tophi.
- Visceral gout is a rare cause of valvular heart nodules.
Implications:
- Accurate diagnosis of acute gout is crucial, especially in athletes, to prevent misdiagnosis as infection.
- Athletes, particularly those exercising in warm weather and consuming alcohol, should be aware of gout risk factors.
- This case highlights the potential for gout to affect cardiac structures, emphasizing the need for comprehensive evaluation.
Abstract:
A 33-yr-old male ran 10 miles, drank some beer, and developed pain in his left knee and ankle. He took some leftover antibiotics but was no better after 6 d, when a heart murmur and an aortic valve nodule were discovered. He was presumed to have endocarditis with septic arthritis and was started on intravenous antibiotics. On the second hospital day, synovial fluid analysis revealed acute gout, and the patient improved very rapidly on anti-gout therapy. The valvular nodule remained unexplained, but one very rare cause of valvular heart nodules is visceral gout. An unsuccessful attempt to resorb the nodule was made by using allopurinol. This patient demonstrates several points about gout in endurance athletes: 1) acute gout can mimic infectious endocarditis, 2) misdiagnosed or undertreated gout often leads to multiple joint involvement and sometimes to visceral tophi, and 3) athletes who exercise in warm weather and quench their thirst with cold beer are at risk for acute gout.