Abstract
A 50-year-old man presented to the emergency department with widespread pain, especially at the chest level, fever, and night sweats. Physical examinations revealed a swelling with localized pain in the left sternoclavicular joint. Laboratory tests showed a CPR of 134 mg/l and an ESR of 70 mm/h. The patient's anamnesis is, for a chronic gouty arthritis, poorly controlled type 2 diabetes and a lumbosacral radicular syndrome. Home therapy includes metformin, sitagliptin, gliclazide, naproxen with partial benefit on pain, and febuxostat. Differential diagnoses of sternoclavicular swelling include infection, crystal or psoriatic arthropathy, tumor pathology, SAPHO syndrome, and osteoarthritis. An ultrasound scan performed at the thoracic level showed the presence of effusion in the sternoclavicular joint. A thoracoabdominal CT scan, performed in doubt of neoplasias, shows no masses but osteostructural nonspecific alterations of the sternoclavicular joint. We performed a dual energy CT (DECT) which reports a gouty arthropathy at the sternoclavicular joints (in the literature, only three similar cases are proved). Because of the poor therapeutic effects using febuxostat and systemic corticosteroids, the patient was treated with anakinra, an interleukin 1 receptor antagonist, which led, 6 months after the event, to a total remission.
Highlights
A 50-year-old man presented to the emergency department with widespread pain, especially at the chest level, fever, and night sweats
Laboratory tests showed a CPR of 134 mg/l and an ESR of 70 mm/h. e patient’s anamnesis is, for a chronic gouty arthritis, poorly controlled type 2 diabetes and a lumbosacral radicular syndrome
E patient’s anamnesis is for a chronic gouty arthritis characterized by the presence of tophi and frequent arthritis; the first gouty attack was in 2011 on the ankles treated with steroids
Summary
R. is a 50-year-old patient who has, since a month, a state of general malaise characterized by widespread pain and intermittent episodes of fever and night sweats. In 2014, he has undergone surgical operation with the removal of tophaceus masses [1] at the sixth compartment of the right hand because of severe pain and losing range of motion in the affected joint He had high uric acid levels (Figure 1) as he consumed febuxostat (allergic to allopurinol). There is a swelling with localized pain in the left sternoclavicular joint. A chest ultrasound showed the presence of effusion in the sternoclavicular joint and thickening of the synovial capsule. Erefore, we continued with a functional ultrasound scan to the knee that showed synovitis with joint effusion and the characteristic double contour that means the presence of deposits of urate at the femoral condyles cartilage level (Figure 3) [1]. E synovial fluid, drawn at the knee level, confirmed this hypothesis given the presence of uric acid crystals
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
