Polyarticular arthropathy and encephalopathy in a 70-year-old woman

Abstract

A 70-year-old woman with a background of portopulmonary hypertension, managed with sildenafil and oral diuretics, and cirrhosis, presented with acute on chronic haemorrhoidal bleeding, iron deficiency anaemia and worsening right heart failure. She presented in a normal conscious and cognitive state. Management involved intravenous diuresis with frusemide and blood transfusion. She quickly begun to develop fever, severe polyarticular arthropathy and progressive encephalopathy. Analgesia was started and antibiotics administered for potential septic sources. Extensive investigations, including full septic screen and neurological imaging, revealed no explainable aetiology for her precipitous decline. She continued to have febrile episodes, worsening polyarticular arthropathy and progressive encephalopathy eventually becoming unresponsive. Given the severe polyarticular arthropathy knee aspiration was performed. Urate crystals were identified and intravenous hydrocortisone and colchicine were started. Within 2 days she achieved full resolution of her systemic, musculoskeletal and neurological symptoms. We propose this as a rare case of gout-induced encephalopathy.

Special Considerations in Geriatric Populations

“…Otherwise, a literature review indicates that studies of delirium in older adults with rheumatic diseases are scant and often limited to case reports. Multiple case reports have described delirium related to acute gout/pseudogout flare that improved with treatment of the flare (86–88). Case reports of older patients with SLE presenting with delirium who responded to treatment with corticosteroids have been described (89,90).…”