Ulcerated gout masquerading as a non healing diabetic foot ulcer: a case series

Authors

  • Winston Crasto Department of Diabetes & Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK
  • Rajesh Jogia Department of Diabetes & Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK
  • Stephen Jackson Department of Diabetes & Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK
  • Kaustubh Nisal Department of Diabetes & Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK
  • Kath Higgins Department of Diabetes & Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK
  • Marie-France Kong Department of Diabetes & Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK

DOI:

https://doi.org/10.15277/bjdvd.2014.004

Abstract

Gout has made a significant resurgence in recent years affecting people with type 2 diabetes, hypertension and chronic kidney disease. Although uncommon, ulcerated gout should be considered in patients presenting with a non healing diabetic foot ulcer, particularly if the first hallux is involved with bony involvement seen on imaging studies. A prior history of gout or hyperuricaemia can be helpful. Early recognition of ulcerated gout masquerading as diabetic foot infection/osteomyelitis and prompt institution of aggressive medical treatment can preserve joint integrity and aid prompt healing. Surgical treatment is usually reserved for intolerable pain, recurrent ulcerations, infection and joint destruction. Our case series highlights the importance of recognising ulcerated gout in patients presenting with a hot swollen foot mimicking osteomyelitis. A high index of suspicion led to revision of diagnosis and subsequent appropriate management with rapid and satisfactory resolution of ulcerated gout.

References

Abbott CA, Carrington AL, Ashe H, et al, and North-West Diabetes Foot Care Study. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med 2002;19:377-84. http://dx.doi.org/10.1046/j.1464-5491.2002.00698.x

Lai HM, Chen CJ, Su BY-J, Chen YC, et al. Gout and type 2 diabetes have a mutual inter-dependent effect on genetic risk factors and higher incidences. Rheumatology 2012;51:715-20. http://dx.doi.org/10.1093/rheumatology/ker373

Rothenbacher D, Primatesta P, Ferreira A et al. Frequency and risk factors of gout flares in a large population-based cohort of incident gout. Rheumatology 2011;50:973-81. http://dx.doi.org/10.1093/rheumatology/keq363

Suppiah R, Dissanayake A, Dalbeth N. High prevalence of gout in patients with type 2 diabetes: male sex, renal impairment, and diuretic use are major risk factors. N Z Med J 2008;121:43-50.

Neogi T. Clinical practice. Gout. N Engl J Med 2011;364:443-52. http://dx.doi.org/10.1056/NEJMcp1001124

Iwamoto T, Toki H, Ikari K et al. Multiple extensor tendon ruptures caused by tophaceous gout. Mod Rheumatology 2010;20:210-12. http://dx.doi.org/10.3109/s10165-009-0258-x

Chen LX, Schumacher HR. Current trends in crystal identification. Curr Opin Rheum 2013;18:171-3. http://dx.doi.org/10.1097/01.bor. 0000209430.59226.0f

Wallace SL, Robinson H, Masi AT, et al. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthrit Rheum 1997;20:895-900. http://dx.doi.org/10.1002/art.1780200320

Rodriguez G, Soriano L, Choi H. Impact of diabetes against the future risk of developing gout. Ann Rheum Dis 2010;69:2090-4. http://dx.doi.org/10.1136/ard.2010.130013

Choi HK, De Vera MA, Kishnan E. Gout and risk of type 2 diabetes among men with a high cardiovascular risk profile. Rheumatology 2008;47:1567-70. http://dx.doi.org/10.1093/rheumatology/ken305

Wordsworth BP, and Mowat AG. Rapid development of gouty tophi after diuretic therapy. J Rheumatol 1985;12:376-77.

Facchini F, Chen Y, Hollenbeck C, Reaven G. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance, and plasma uric acid concentration. JAMA 1991;266:3008-11. http://dx.doi.org/10.1001/jama.1991.03470210076036

Yu KH, Luo SF, Liou LB, et al. Concomitant septic and gouty arthritis-an analysis of 30 cases. Rheumatology 2003;42:1062-66. http://dx.doi.org/10.1093/rheumatology/keg297

Dalbeth N, McQueen FM. Use of imaging to evaluate gout and other crystal deposition disorders. Curr Opin Rheumatol 2009;21:124-31. http://dx.doi.org/10.1097/BOR.0b013e3283257b6c

Brower AC, Flemming DJ. Gout. In: Arthritis In Black and White. 2nd ed. Philadelphia: WB Saunders; 1997:325-341.

Yu J, Chung C, Recht M, et al. MR imaging of tophaceous gout. Am J Roentgenology 1997;168:523-7. http://dx.doi.org/10.2214/ajr.168.2.9016240

Kumar S, Gow P. A survey of indications, results and complications of surgery for tophaceous gout. NZ Med J 2002;115:U109.

Lee SS, Chen MC, Chou YH, et al. Timing of intra-lesion shaving for surgical treatment of chronic tophus. J Plast Reconstr Aesthet Surg 2013; 66:1131-37. http://dx.doi.org/10.1016/j.bjps.2013.03.041

Lee SS, Sun IF, Lu YM, Chang KP, et al. Surgical treatment of the chronic tophaceous deformity in upper extremities - the shaving technique. J Plast Reconstr Aesthet Surg 2009;62:669-74. http://dx.doi.org/10.1016/j.bjps.2007.12.021

Lee JH, Park JY, Seo JW, et al. Surgical treatment of subcutaneous tophaceous gout. J Plast Reconstr Aesthet Surg 2010;63:1933-35. http://dx.doi.org/10.1016/j.bjps.2010.03.019

Larmon W, Kurtz J. The Surgical Management of Chronic Tophaceous Gout. J Bone Joint Surg 1958;40:743-72.

BJDVD Volume 14 Issue 1

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Published

2014-04-01

Issue

Vol. 14 No. 1 (2014)

Section

Achieving best practice

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