A case of gouty arthritis following percutaneous radiofrequency ablation for hepatocellular carcinoma

Abstract

Percutaneous radiofrequency thermal ablation (RFA) is considered an effective technique for providing local control in the majority of Hepatocellular carcinoma (HCC) patients. Although RFA is generally well tolerated, recent studies have reported complications associated with RFA. We describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal insufficiency. Regular surveillance of the patient detected a 3.5 cm HCC lesion. Because the patient had declined surgery, RFA was chosen for therapy. On the third post-procedural day, the laboratory results showed increases in his uric acid and potassium levels, which were compatible with a tumor lysis syndrome. On the 6th post-procedural day, the patient complained of new right knee pain. Subsequent joint aspiration revealed monosodium urate monohydrate crystals. We made the diagnosis of acute gouty arthritis arising from tumor lysis and liver infarction caused by HCC ablation, which was aggravated by acute renal insufficiency. After adequate hydration and administration of oral colchicines, the patient's right knee pain subsided and the uric acid serum level returned to normal. This is the first described case of acute gouty arthritis after RFA for a HCC lesion in a patient with underlying chronic renal insufficiency. To avoid hyperuricemia and an acute attack of gout after RFA therapy for HCC, early identification of patients at risk is warranted, such as those with a large tumor, rapid tumor growth, and renal insufficiency, and preventative measures should be considered.

Figure 1

Computed tomography (CT) scan of the patient. A: CT scan in an arterial phase demonstrates a 3.5 cm hepatocellular carcinoma lesion (arrows) at segment IV of the liver adjacent to the gallbladder, posterior to the lesion where a previous percutaneous ethanol injection has been performed; B: CT scan obtained after radiofrequency thermal ablation reveals complete ablation for the hepatocellular carcinoma without apparent complications such as a gallbladder injury on the immediate follow-up.

Figure 2

A simple abdominal radiograph reveals no evidence of bowel perforation, except a distension of the large intestine.

Figure 3

Strongly negative birefringent, needle-shaped monosodium urate crystals (arrow) in synovial fluid from a patient under compensated polarized light.