093 The role of US in an atypical presentation of gout

Le résumé fourni par la source

Background: A 54 year old male with no prior rheumatological history presented to the emergency department with an atraumatic acute swelling of his 3rd finger and left hand following a round of golf which failed to respond to one week of oral flucloxacillin, (CRP 2, ESR 31, WCC 8, and urate 409). A presumed diagnosis of flexor tendon sheath infection was made and he underwent incision and drainage. Chalky fluid was seen intraoperatively around the tendon sheath, cultures of which after extended growth were negative. Fluid was not sent for microscopy. He received intravenous antibiotics and was discharged after 48 hours. He represented a week later with continued widespread swelling and erythema of the hand and 3rd finger and very restricted movement. His uric acid level was 375. CRP was again, normal. He received further IV antibiotics with no clinical improvement. An MRI of the hand raised the possibility of osteomyelitis, oedema was noted at the third MCP joint and possible bone marrow oedema at the base of the 3rd finger proximal phalanx. Ultrasound of the hand clearly demonstrated a double contour sign (DCS) (a typical founding in gout) at the 3rd MCP joint and marked synovitis with power Doppler grade 3 and greyscale synovial hypertrophy grade 2 in the same location. He responded well to US guided corticosteroid injection and Naproxen.

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