A Tale of Two Diagnoses; Gout Vs Chronic Osteomyelitis. A Case Report

Abstract

Gout can potentially be diagnosed clinically and treated, if classical symptoms are present. In some cases, gout and osteomyelitis can have similar presenting signs and symptoms and it may be difficult to differentiate just on clinical presentation, routine laboratory workup and imaging like radiography or ultrasound. Arthrocentesis can be crucial in such scenarios to differentiate the two entities as missed opportunity to treat infectious etiology can have detrimental outcomes. We present a case of patient with ankle pain and swelling treated as recurrent gout, as there were no risk factors for osteomyelitis. Arthrocentesis confirmed the diagnosis of osteomyelitis and patient was treated with intravenous antibiotics, resulting in resolution of symptoms.

Keywords: Chronic osteomyelitis; Gout; Joint pain; Osteomyelitis.

Fig. 1

(a and b): No acute fracture or dislocation was seen on AP and lateral view of left foot and ankle x-rays.

Fig. 2

Left ankle histopathology specimen from debridement showing acute and chronic inflammatory changes.

Fig. 3

Biopsy specimen from the left tibia showing segments of bone with reactive features and chronic osteomyelitis including chronic inflammation with plasma cells.