1/12. Multicentric reticulohistiocytosis: a mimic of gout and rheumatoid arthritis.Multicentric reticulohistiocytosis is a rare cutaneous-articular disease that may mimic more common disorders such as rheumatoid arthritis or tophaceous gout. In one fourth of patients, it is a paraneoplastic process. This brief overview is aimed at physicians who care for patients with polyarthritis, to alert them to distinctive features that differentiate multicentric reticulohistiocytosis from the common arthritides.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/12. gout, bradycardia, and hypercholesterolemia after renal transplantation.Approximately 17,000 solid organ transplantations are done annually in the united states. Increasingly, care of these patients will be provided by primary care physicians. In this report, we illustrate the complexity of common medical problems in a patient who had cellulitis and who had had a cadaveric renal transplantation 10 years earlier. Immunosuppressive therapy was cyclosporine (100 mg twice a day) and prednisone (10 mg once a day). The patient's hospital course was complicated by acute gout and symptomatic bradycardia. In both instances, usual treatment--full-dose indomethacin for gout and withholding verapamil for bradycardia--could have had significant interaction with the cyclosporine. At the time of discharge, a therapeutic plan for long-term management of hypercholesterolemia included possible drug interactions with cyclosporine. The potential for drug toxicity in the transplant patient necessitates careful monitoring of immunosuppressive drug levels. Ongoing communication with the transplant center is also needed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/12. Gouty tophi: a squamous cell carcinoma mimicker?BACKGROUND: Digital lesions can have a broad differential diagnosis. Squamous cell carcinoma (SCC), the most common digital malignant neoplasm, must be excluded as the cause of persistent digital lesions causing nail dystrophy. OBJECTIVE: To describe a patient with a periungual hyperkeratotic lesion on the left fifth digit which, upon initial dermatopathologic examination, appeared to be a malignancy. However, on further biopsy, the lesion proved to be a gouty tophus. methods: Case report and literature review. RESULTS: An 84-year-old white man presented with a hyperkeratotic papule on the lateral proximal nail fold of the left fifth digit, which resulted in nail dystrophy for 1 year. Similar lesions were present on several other digits which did not affect the nail plate. Initial biopsy was consistent with actinic keratosis and was treated with cryotherapy. When the lesion persisted, repeat biopsy was performed, demonstrating fragments of squamous epithelium with focal atypia and an infiltrative growth pattern. SCC could not be excluded and the patient was referred for Mohs micrographic surgery (MMS) consultation. An excisional biopsy was performed and a white chalky material was observed at the base of the defect. Histopathology confirmed a gouty tophus. The patient was referred to his primary care physician and was treated with allopurinol. CONCLUSION: This is the first report of gouty tophus of the periungual region presenting as a hyperkeratotic lesion. Initial clinical diagnosis favored SCC and histologic evidence suggested a possible early SCC. This lesion can be confused with digital squamous cell carcinoma. The presence of pseu- docarcinomatous hyperplasia may complicate accurate diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/12. Longitudinal tears of both peroneal tendons associated with tophaceous gouty infiltration. A case report.The authors report a case of longitudinal tendon tears of the peroneus longus and brevis in the presence of tophaceous gouty infiltration. There are a limited number of reports discussing similar processes affecting various tendons throughout the body. There has been 1 prior case of peroneal tendon involvement affecting only the peroneus brevis. A 35-year-old man presented with a 4-year history of left-sided lateral ankle pain, redness, and swelling. The patient described the "attacks" as occurring off and on, with a recent increase in frequency. The symptoms were relieved with indomethacin, colchicine, and narcotic analgesics. Upon clinical evaluation, there was a cavus foot type with moderate calcaneal varus. Peroneal subluxation was elicited with resisted eversion. An MRI evaluation revealed longitudinal tears of both peroneal tendons. During surgical repair, a chalky-white substance resembling gouty tophi was present within both tendon tears. The tendons were remodeled and repaired. The patient had an uneventful postoperative course with nearly completed resolution of his symptoms at 1-year follow-up. The patient was referred to his primary care physician for further evaluation and long-term control of elevated uric acid levels.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/12. Three clinical problems: weird thyroid function tests, difficult gout, and dementia.Speakers at the course were given vignettes describing one or more clinical scenarios on which to base their talks, selected because they represent common but challenging problems likely to be encountered by any physician practising in general internal medicine. Three of the subjects covered--weird thyroid function tests, difficult gout, and dementia--are presented here.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/12. Rheumatologic conditions of the wrist.With the exception of the arthritis associated with rubella, acute wrist conditions have no pathognomonic physical findings. The primary physician can diagnose and treat the majority of wrist problems presented. Referral to a rheumatologist is necessary only when confronted with an anxious patient or an individual having persistent wrist pain and swelling of obscure etiology. This article focuses on rheumatologic problems of the wrist that are most likely to come to the attention of the primary physician.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
7/12. gout presenting as a popliteal cyst. A case of pseudothrombophlebitis.A 64-year-old man with progressive swelling and erythema of his right calf preceded by dull aching in the right popliteal fossa was presumed to have deep vein thrombophlebitis. A venogram revealed normal circulation in the right lower leg, and an ultrasound examination of the right popliteal fossa revealed a 2 X 5-cm popliteal cyst. Fluid aspirated from the cyst confirmed the diagnosis of gout. Popliteal cysts associated with gout are rare, and those that rupture, leak, dissect, or enlarge can mimic thrombophlebitis (a phenomenon known as pseudothrombophlebitis). Thus, the primary care physician should consider the diagnosis of popliteal cyst in patients who appear to have deep vein thrombophlebitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/12. Reversible acute renal insufficiency and hyperkalemia following indomethacin therapy.We noted five cases of reversible acute deterioration of renal function in patients with very mild to moderate renal insufficiency who received indomethacin for an acute gouty attack. This decrease in renal function was consistent with a primary decrease in renal blood flow. In addition, hyperkalemia developed in the patients, which we attribute to a decrease in renin and aldosterone secretion, a decrease in distal tubular delivery of sodium, and, more importantly, to a decrease in urine flow. This report is intended to alert physicians to the possible complications of indomethacin therapy in patients with mild renal insufficiency.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/12. Unusual presentations of gout. Tips for accurate diagnosis.In cases of unusual presentations, such as the three cases described here, gout or gouty arthritis may be misdiagnosed as rheumatoid arthritis, septic arthritis, or other rheumatic conditions and thus inappropriately treated. Microscopic analysis using compensated polarized light and culture of synovial fluid helps distinguish gouty arthritis from other arthropathies, and the presence of monosodium urate crystals establishes the diagnosis of gout. When gout is suspected, yet the initial examination does not reveal the telltale crystals, reexamination of synovial fluid is warranted. It is important for physicians to remember, though, that diagnosis of gout does not rule out the possibility of concurrent arthritic conditions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/12. female premenopausal tophaceous gout induced by long-term diuretic abuse.We describe 3 cases of tophaceous gout affecting premenopausal women. The only precipitating factor to be found was the chronic and unnecessary overuse of furosemide, apparently resulting from a psychological profile of anorexia nervosa. Our cases emphasize the need for physicians to look for hidden abuse of diuretics in the presence of gouty arthritis in menstruating women, especially if tophi are noted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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