open access

Vol 14, No 4 (2019)
Case Reports
Published online: 2019-07-01
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Diuretic-induced hyperuricemia presenting as malignant gout in a 19 year-old male with moderate rheumatic mitral stenosis

Santosh Kumar Sinha, Vinay Krishna, Abhishekh Aggarwal, Kumar Himanshu, Lokendra Rekwaal
DOI: 10.5603/FC.a2019.0071
·
Folia Cardiologica 2019;14(4):401-403.

open access

Vol 14, No 4 (2019)
Case Reports
Published online: 2019-07-01

Abstract

Gout, an inflammatory arthritis, is caused by an accumulation of monosodium urate crystals in the joints and soft tissues when serum uric acid concentrations rise above the physiological saturation limit (≥ 6.4 mg/dL).

Here, we report the case of a 19 year-old male who presented with gradually progressive, nontender swelling of multiple joints of the upper and lower limbs of eight months’ duration. He had been receiving frusemide 40 mg, spirinolactone 50 mg, metoprolol 50 mg, and erythromycin 250 mg twice daily for the previous 12 months on account of rheumatic mitral stenosis (moderate). Though a histological diagnosis of gout is the gold standard, in our case we diagnosed frusemide-induced secondary gout with malignant course. This was based on a combination of an imaging tool (radiology showing well defined, ‘punched-out’ erosions with overhanging edges), and clinical presentation (soft tissue nodules, i.e. tophi, calcification of tophi, and asymmetric involvement). Frusemide was stopped, allopurinol and other urate lowering agent were started which led to regression of his swelling.

Abstract

Gout, an inflammatory arthritis, is caused by an accumulation of monosodium urate crystals in the joints and soft tissues when serum uric acid concentrations rise above the physiological saturation limit (≥ 6.4 mg/dL).

Here, we report the case of a 19 year-old male who presented with gradually progressive, nontender swelling of multiple joints of the upper and lower limbs of eight months’ duration. He had been receiving frusemide 40 mg, spirinolactone 50 mg, metoprolol 50 mg, and erythromycin 250 mg twice daily for the previous 12 months on account of rheumatic mitral stenosis (moderate). Though a histological diagnosis of gout is the gold standard, in our case we diagnosed frusemide-induced secondary gout with malignant course. This was based on a combination of an imaging tool (radiology showing well defined, ‘punched-out’ erosions with overhanging edges), and clinical presentation (soft tissue nodules, i.e. tophi, calcification of tophi, and asymmetric involvement). Frusemide was stopped, allopurinol and other urate lowering agent were started which led to regression of his swelling.

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Keywords

diuretic, monosodium urate, malignant gout, rheumatic mitral stenosis, tophi

About this article
Title

Diuretic-induced hyperuricemia presenting as malignant gout in a 19 year-old male with moderate rheumatic mitral stenosis

Journal

Folia Cardiologica

Issue

Vol 14, No 4 (2019)

Pages

401-403

Published online

2019-07-01

DOI

10.5603/FC.a2019.0071

Bibliographic record

Folia Cardiologica 2019;14(4):401-403.

Keywords

diuretic
monosodium urate
malignant gout
rheumatic mitral stenosis
tophi

Authors

Santosh Kumar Sinha
Vinay Krishna
Abhishekh Aggarwal
Kumar Himanshu
Lokendra Rekwaal

References (4)
  1. Choi HK, Mount DB, Reginato AM, et al. American College of Physicians, American Physiological Society. Pathogenesis of gout. Ann Intern Med. 2005; 143(7): 499–516.
  2. Zhang W. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the standing committee for international clinical studies including therapeutics (ESCISIT). Ann Rheum Dis. 2006; 65(10): 1301–1311.
  3. Gentili A. The advanced imaging of gouty tophi. Curr Rheumatol Rep. 2006; 8(3): 231–235.
  4. Rettenbacher T, Ennemoser S, Weirich H, et al. Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray. Eur Radiol. 2008; 18(3): 621–630.

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