Septic Arthritis Complicating a Gout Flare: Report of Two Cases and Review of the Literature

Abstract

Objective: To highlight potential pitfalls in diagnosis and management of patients with concomitant gout and septic arthritis. Methods: Presentation of two patients with concomitant gout and septic arthritis, the latter caused by Streptococcus agalactiae and Staphylococcus aureus , in one patient each. We also reviewed the English language literature on PubMed for similar cases. Results: Data on concurrent gout and septic arthritis is limited. Three case series of 14, 25, and 30 patients each where identified. The coexistence of septic arthritis and gout is an infrequent condition. Clinical appearance of the two diseases may be very similar and the presence of monosodium urate (MSU) crystals per se cannot exclude infection. On the other hand, patients with chronic tophaceous gout are prone to infection of MSU tophi and the development of biofilms on the latter may render the eradication of microbes particularly difficult. Vice versa, persistent activation of the immune system fuelled by the infection, together with prolonged hospitalisation and immobilisation, may increase the risk for a gout flare, thus initiating a vicious cycle. Conclusion: In patients with gout, a high index of suspicion for infection is needed by treating physicians, because septic arthritis is a medical emergency which can lead to rapid joint destruction.

Gouty tenosynovitis with compartment syndrome in the hand: A case report

“…The deposition of monosodium urate crystals within the flexor tendons and synovial sheaths triggers an acute inflammatory response, resulting in swelling, redness, and severe pain in the affected hand[ 2 - 4 ]. Previous studies have emphasized that recognizing gouty tenosynovitis of the hand is vital for early intervention, as a delayed diagnosis can lead to severe complications, as observed in our case[ 3 ].…”

Rare Case of Gout Leading to Septic Arthritis, Osteomyelitis, and Septic Shock in an Elderly Patient

“…In contrast to our patient, orthopedic examination consulted against surgical consultations and the patient's blood cultures were sterile. The patient received empiric treatment of IV daptomycin and levofloxacin for septic arthritis, which was then tailored to penicillin and levofloxacin after the cultures resulted [2].…”

Complex Case: Acute-on-Chronic Gouty Arthritis, Septic Arthritis, and Severe Joint Deformities in a Young Adult Patient

“…3 On the other hand, septic arthritis represents a critical emergency scenario that could culminate in cartilage degradation, significant disability, and elevated mortality rates. [4][5][6] The concurrent occurrence of gouty arthritis and septic arthritis is an uncommon medical phenomenon that often presents diagnostic challenges, potentially resulting in unfavorable outcomes. 6 In this study, we discuss the case of a 34-year-old male who was suspected to have gout flare and was ultimately diagnosed with septic arthritis complicating gout.…”

“…[4][5][6] The concurrent occurrence of gouty arthritis and septic arthritis is an uncommon medical phenomenon that often presents diagnostic challenges, potentially resulting in unfavorable outcomes. 6 In this study, we discuss the case of a 34-year-old male who was suspected to have gout flare and was ultimately diagnosed with septic arthritis complicating gout. We conduct a literature review focusing on the simultaneous occurrence of these two conditions, emphasizing potential challenges in their diagnosis and treatment.…”

“…21 Distinguishing between septic arthritis and other types of arthritis, such as crystal-induced or rheumatoid arthritis, can pose significant challenges. 6 The clinical manifestations of gout and septic arthritis can often overlap, presenting with pronounced inflammation, fever, swelling, redness, pain, and restricted range of motion in the affected joints. 22 In conclusion, we present a patient with septic arthritis and chronic gout; these two conditions require timely diagnosis and efficient management, frequently involving a combination of antibiotic treatment, surgical drainage, and anti-inflammatory medications.…”