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Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

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American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
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Journal of Cancer Research and Treatment
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When Crystal Arthropathy Presents as Blood Poisoning

Kourosh Shargani*, Harry Fischer

Northwell Lenox Hill Hospital, New York, NY. 100 E 77th St, New York, NY 10075, USA

Abstract: Gout, or monosodium urate crystal deposition, is a common presentation in adults usually affecting the great toe. Gout is caused by an elevated level of uric acid in the blood, which leads to painful crystal deposition in the joints. Common causes of gout are Hypertension (HTN), Chronic Kidney Disease (CKD), Diabetes Mellitus (DM), alcohol use, diuretics, and high purine meals such as red meat or seafood. Gout flares present with sudden onset pain, warmth, and swelling in a single joint. These symptoms are very similar to an acute septic joint presentation. This case will demonstrate the workup required to differentiate between the two pathologies.

Keywords: septic arthritis, crystal arthropathy, sepsis, gout, gout-flare

Received April 02, 2021; Revised May 03, 2021; Accepted May 10, 2021

Citation: Kourosh Shargani, Harry Fischer, When Crystal Arthropathy Presents as Blood Poisoning. American Journal of Medical Case Reports, 9 (8). 432-433. January 2021. doi:10.12691/ajmcr-9-8-12

1. Introduction

Gout is common in adults, usually affecting the hallux. It is caused by elevated level of uric acid in the blood leading to painful crystal deposition in the joints [1]. Common causes of gout are hypertension, chronic kidney disease, diabetes mellitus, alcohol use, diuretics, and a high purine diet [2]. Gout flares usually present with pain, warmth, and swelling in a single joint. It can be difficult to distinguish between crystal arthropathy and infection, which can lead to delayed treatment and further damage to the joint [3]. The two pathologies should be differentiated with arthrocentesis when suspected [3].

2. Case Description

A 69-year-old male presented with left knee pain for 3 days. He denied fever, chills, or trauma to the knees, however endorsed increased urinary frequency. He had history of hypertension, hyperlipidemia, and chronic kidney disease. Labs significant for leukocytosis of 17.16 K/uL and urinalysis with positive nitrites. On exam, patient with left knee warmth, tenderness, with additional swelling in right knee. X-ray of both knees showed bilateral osteoarthritis. He was admitted for UTI management. The next day, patient had new fever to 102.7F rectal. Labs showed ESR of 105 mm/hr and a CRP of 31 mg/dl. There was concern for septic arthritis and antibiotics were broadened to vancomycin and zosyn. Synovial fluid studies showed left knee with positive monosodium urate crystals, 17,900 cell count, 500,000 red blood cells, monocyte 5%, no white blood cells or organisms. The right knee showed positive monosodium urate crystals, 101,000 cell count, 2000 red blood cells, monocyte 6%, no white blood cells or organisms. Antibiotics were discontinued after 24 hours of negative blood and synovial fluid cultures. The patient was diagnosed with gout and started on colchicine with resolution of symptoms.

3. Discussion

Gout affects the first metatarsophalangeal joint in 73% of cases and one single joint in 90% of cases [1]. In this case, the patient showed atypical bilateral knee involvement. This patient’s flare may have been exacerbated by his alcohol use or UTI. During gout flare, macrophages phagocytize monosodium urate crystals leading to release of inflammatory markers such as interleukin-6, tumor necrosis factor, and cyclooxygenase [4]. This same inflammatory process occurs with septic arthritis. Gout flare and septic arthritis both present with similar exam findings, elevated inflammatory markers, and non-specific imaging. Although this patient did not have infection, it is important to recognize that septic arthritis can occur concurrently with an acute gout flare and should be ruled out with a negative synovial fluid gram stain and culture.

References

[1]   | Engel B, Just J, Bleckwenn M, Weckbecker K: Treatment Options for Gout. Dtsch Arztebl Int. 2017, 114: 215-222.
[2]   | Fenando A, Widrich J. Gout. [Updated 2020 Aug 8]. In. StatPearls [Internet, Treasure Island (FL): StatPearls Publishing; 2020 Jan-.
[3]   | Yu KH, Luo SF, Liou LB, et al.: Concomitant septic and gouty arthritis--an analysis of 30 cases. Rheumatology (Oxford. 2003, 42:1062-1066.
[4]   | Shah D, Mohan G, Flueckiger P, Corrigan F, Conn D: Polyarticular Gout Flare Masquerading as Sepsis. Am J Med. 2015, 128:11-12.
[5]   | Visser S, Tupper J: Septic until proven otherwise: approach to and treatment of the septic joint in adult patients. Can Fam Physician. 2009, 55: 374-375.