Occurrence of gout in a female; report of an unusual case.

Abstract

Gout is found predominantly in males. According to one textbook, less than 5 per cent of the cases occur in females (1). Vorhaus (2), however, believes that statistics which indicate so great a discrepancy in sex incidence are inaccurate, and that there is a greater frequency of gout in women than is commonly accepted. A number of such cases have appeared in the literature (2–6). The case to be presented here, seen in a young woman, is interesting also for the rapidity with which the disease has developed, the marked arthritis and bone destruction, and the accompanying amenorrhea. Case Report Mrs. Lillian L., a woman of 28, was first admitted to the hospital in August 1950. She had been suffering from polyarticular arthritis for the past two years, and a diagnosis of gout had been made the previous year. She had been in good health until her first pregnancy, when she had pre-eclampsia. Following delivery, in January 1944, severe anemia and uremia developed, as well as intermittent edema of the lower extremities, the latter lasting for a year. Recovery from this episode appeared to be complete, however, and the patient's health remained good until her second pregnancy, when she again had hypertension, peripheral edema, and albuminuria. While she was pregnant she experienced increasing pain in the left flank. Delivery, in April 1948, was normal. A few months following the second delivery, there occurred a painful swelling of the great toes of both feet and of both ankles, followed shortly by similar symptoms in the hands and right elbow. Pain in the left flank continued. The patient was admitted to another hospital in September 1949, where a small contracted left kidney was removed and the spleen was found to be greatly enlarged. A diagnosis of gout was made at that time. Roentgenograms showed extensive destructive arthritis of the right foot and ankle. A draining sinus was present just below the right lateral malleolus. The patient complained of pain in the left lower extremity as well as the hands, but roentgenograms showed no bone damage at that time. Her menstrual periods had become irregular. The last had occurred May 28, 1950, and the one prior to that March 8, 1950. There was no family history of gout. On her admission to the Indiana University Medical Center Hospitals, the patient weighed about 150 pounds and appeared well developed. Her temperature was 98° F.; the pulse was 78, and the respirations were 16. The blood pressure was 120/80. One-plus pitting edema of the feet and legs was present. The first metatarsophalangeal joints and the medial malleoli of both feet were swollen and discolored. Fluid was demonstrated in the ankle joint and the first metatarsophalangeal joint of the left foot. The hands were swollen, and nodules could be palpated over various bony prominences. Several of these were removed for microscopic study and chemical analysis. Biopsy of one of them, over the olecranon process of the right elbow, was reported (by Dr. J. L. Arbogast) as follows: “The specimen consists of firm white tissue which on cut section shows small deposits of chalky white tissue. Histologic study of this tissue shows large and small irregularly circular or oval deposits of lavender- or blue-staining material which is amorphous or granular, occasionally crystalline. These deposits are found in dense connective tissue and only a few lymphocytes are present. These features are consistent with those found in the deposition of urate crystals in the tophi of gout.”