Monoarticular Crystal Arthropathy of the Knee: Tophaceous Gout

Abstract

Tophaceous gout is a crystal arthropathy and a disorder of purine metabolism characterized by monosodium urate crystal deposition. A case of tophaceous gout of the knee joint in a 30-year-old female is reported, and the imaging appearances on high-resolution ultrasonography are described. The patient presented with complaints of insidious onset painless swelling of the left knee joint with limitation of range of movement for 1 week. The aspirated joint fluid demonstrated needle-like monosodium urate crystals showing strong negative birefringence consistent with a diagnosis of tophaceous gout. Targeted urate-lowering treatment included oral nonsteroidal anti-inflammatory drugs and oral colchicine. Prophylactic treatment for gout flare-ups included initiation of allopurinol at 300 mg/day along with modification of the dietary regimen including limited consumption of red meat and increased consumption of low-fat dairy products. Symptomatic improvement with reduced pain and swelling of the knee joint was noted at 10 days after treatment. Subsequently, at 3-month follow-up, the patient was disease free with no signs of recurrence and serum uric acid levels at 3.7 mg/dL. In spite of a wide range of therapeutic options available for the management of tophaceous gout, suboptimal management of gout is prevalent till date in both developing and developed nations across the world.

Gallbladder Diverticulum as a Rare Disease and a Therapeutic Challenge: A Case Report

“…Clinically, patients with gallbladder diverticula may be asymptomatic or present with symptoms that mimic cholecystitis, such as right upper quadrant pain, nausea, and vomiting [ 1 , 4 , 7 - 9 ]. This overlap in symptoms can complicate the diagnostic process.…”

“…Ultrasonography is the first-line imaging modality for diagnosing gallbladder diverticulum due to its accessibility and non-invasiveness [ 9 , 10 ]. However, its sensitivity can be limited, necessitating additional imaging techniques such as CT or magnetic resonance imaging (MRI) to confirm the diagnosis and rule out other pathologies.…”

“…Asymptomatic cases may be managed conservatively with regular follow-up [ 11 ]. However, symptomatic patients or those with complications such as recurrent cholecystitis or suspicion of malignancy typically require surgical intervention [ 6 , 9 ]. LC is the preferred surgical approach due to its minimally invasive nature and reduced recovery time compared to open surgery.…”