Acute gout presenting in the manubriosternal joint

Abstract

A 54-year-old black man developed acute pain and swelling of the manubriosternal joint. Acute gouty arthritis was diagnosed by arthrocentesis and polarizing microscopy. The histology of the manubriosternal joint and its involvement in other arthritides are briefly discussed.Acute gout may involve the chest wall by agecting the sternoclavicular (1,2) or the costochondral articulation (1). We describe a patient who presented with an acute monarticular manubriosternal arthritis as his initial manifestation of gout.Case report. The patient, a 54-year-old black man, presented to the Duke University Medical Center emergency room with an 18-hour history of tenderness and mild swelling over the upper sternum. He complained of pain in his mid-anterior chest wall with any motion of his shoulders or with deep inspiration.He: denied trauma, recent exertion, alcohol ingestion, fever, or any rheumatic complaints.His other medical problems included noninsulin-dependent diabetes mellitus, hypertension treated with thiazide diuretics, and mild renal insufficiency (creatinine 2.1 mg/dl). A previous uric acid determination was noted to be 9.6 mg/dl. He denied any history of acute or chronic arthritis. One year previously, he had been hospitalized for acute chest --__

Gouty arthritis in the manubriosternal joint

“…4 The rarity of MSJ involvement may be because of several reasons: firstly, only 30% of adults with chronic gout would show cavitation of MSJ that may predispose to urate crystal deposition; secondly, the more centrally a joint is located, the most uncommon is gouty involvement; thirdly, pain over the sternum in patients with chronic gout may be interpreted to be related to other causes and disappear with treatment for gout. In this case, as in both previously reported,3 4 urate crystals were observed in fluid aspirated from the MSJ. The patient observed by Shrewing and Carvell4 suffered recurrences despite appropriate treatment and underwent MSJ arthrodesis.…”

Tophaceous gout of the first costochondral junction in a heart transplant patient

“…Acute attacks of manubriosternal joint gout have been previously described [18,19], and gout has been reported in the sternoclavicular joint [20]. To our knowledge, however, this is the first reported case in the English literature of gout at the costochondral junction.…”

Misdiagnosis of a chylous cyst as chest wall gouty tophus: A case of true pseudogout

“…Gout is best diagnosed when negatively birefringent, needle‐shaped monosodium urate crystals are viewed using polarized light microscopy. Gout may involve the chest wall by affecting sternoclavicular (14, 15), costochondral (14), or manubriosternal (16, 17) articulations. Subcutaneous tophus formation by crystal deposition is rare in other conditions except gout.…”