Transcript Primary Impression

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