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Transcript
Primary Impression • Acute gouty arthritis on top of chronic tophaceous gout • Ulceration with secondary bacterial infection of the foot Differential Diagnosis Patient Septic arthritis • 60 y/o • Male • No age predilection • No sexual predilection • Recurrent joint pains • Limitation of movements • Alcoholic beverage drinker • (+) swelling on the wrists to hands, ankles to feet, warm to touch • Presence of joint deformities • (+) Hyperuricemia • • • • Chronic tophaceous gout • Older age group • M>F before menopause; M=F after menopause Acute joint pains • Recurrent joint pains Limitation of • Limitation of movements movements N/A • (+) Alcoholic beverage drinker Warm to touch; swelling • swelling on the wrists to on involved joints hands, ankles to feet • (+/-) joint deformity • (-) Hyperuricemia • Presence of joint deformities • (+) Hyperuricemia Differential Diagnosis Patient Diabetic Foot Ruptured Tophi • Presence of ulcers on the foot with white chalky substance Ulcers without white chalky substance Ulcers with white chalky substance Anemia due to: NSAID Gastropathy Chronic Kidney Disease Hypochromic and microcytic anemia (↓ iron) Normocytic and normochromic anemia (↓EPO) (+) FECAL OCCULT BLOOD TEST + - Chronic NSAID use (Alaxan-paracetamol+ibuprofen; Mefenamic acid) + - <20-25% 20 to 30% Patient Hypochromic microcytic anemia Hct 16% Hawkey CJ. Non-steroidal anti-inflammatory drug gastropathy: causes and treatment. Scand J Gastroenterol Suppl. 1996;220:124-7. CATHERINE S. SNIVELY, M.D.,et.al. Chronic Kidney Disease: Prevention and Treatment of Common Complications. Am Fam Physician. 2004 Nov 15;70(10):1921-1928. Main Diagnosis • Acute gouty arthritis on top of chronic tophaceous gout • Ruptured tophi with secondary bacterial infection of the foot with osteomyelitis • Anemia secondary to occult GI bleeding probably due to NSAID gastropathy • Chronic kidney disease secondary to gout