Chronic, Long-Lasting, and Untreated Gout with Concomitant Dilated Cardiomyopathy and Exceptionally Vast Anasarca: Case Report
| Autor: | Petra Šulentić, Branko Bečejac, Ozren Vinter, Milan Vrkljan |
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| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: | |
| Zdroj: | Acta clinica Croatica Volume 50 Issue 3 |
| ISSN: | 1333-9451 0353-9466 |
| Popis: | Gout is the most common type of inflammatory arthritis in man caused by deposition of urate crystals into the joints as the result of elevated serum urate levels. A case of a 59-year-old patient with untreated, long-lasting gout and clinical manifestation of decompensated global dilated cardiomyopathy is presented. Examination revealed generalized pitting edema extending from both lower extremities to the sacrum, abdominal, and thoracic wall, with scrotal swelling and upper extremity involvement, an exceptionally vast generalized edema, i.e. anasarca. Proximal and distal interphalangeal joints of the hands and feet were swollen and deformed, with marked yellow tophi nodules. Laboratory studies revealed high serum uric acid concentration (546 μmol/L), decreased creatinine clearance (0.8 mL/s) and albumin concentration (27.4 g/L), as well as increased total urine protein mass (0.35 g/24 h). X-rays of the affected feet and fists showed punched-out lesions of the subchondral bone with overhanging bony margins in the first metatarsophalangeal, proximal, and distal interphalangeal joints of both hands. The extreme clinical presentation resolved upon intravenous administration of diuretics and pleurocentesis, followed by oral medications including furosemide, angiotensin-converting enzyme inhibitor, spironolactone and digoxin. Since serum urate level has been identified as an independent risk factor for the development of ischemic heart and chronic kidney disease, regulation of urate concentration is necessary, especially in patients diagnosed with gout. Giht je najčešći tip upalnog artritisa, a uzrokovan je nakupljanjem kristala urata u zglobovima kao rezultat povišene razine urata u serumu. Prikazan je slučaj 59-godišnjeg bolesnika s neliječenim uričnim artritisom i kliničkom manifestacijom globalno dekompenzirane dilatacijske kardiomiopatije. Kliničkim pregledom dominirala je anasarka, tj. opsežan generalizirani tjestasti edem oba gornja i donja ekstremiteta, skrotalni otok, edem trbušne i prsne stijenke. Proksimalni i distalni interfalangealni zglobovi šaka i stopala bili su otečeni i deformirani, uz vidljive žute čvoričaste tofe. Laboratorijski testovi pokazali su visoku koncentraciju mokraćne kiseline u serumu (546 μmol/L), smanjeni klirens kreatinina (0,8 mL/s) i koncentraciju albumina (27,4 g/L), te povišenu ukupnu masu bjelančevina u mokraći (0,35 g/24 h). Rendgenske snimke zahvaćenih stopala i šaka pokazale su destrukcije i rubne uzure s uzdignućem korteksa u prvom metatarzofalangealnom, proksimalnom i distalnom interfalangealnom zglobu obiju šaka. Ova ekstremna klinička slika riješena je intravenskom primjenom diuretika i pleurocentezom, nakon čega je slijedila oralna terapija uključujući furosemid, inhibitor enzima za konverziju angiotenzina, spironolakton i digoksin. Kako su serumske razine urata utvrđene kao neovisan čimbenik rizika za razvoj ishemijske srčane i kronične bubrežne bolesti, regulacija koncentracije urata je neophodna, naročito kod bolesnika s dijagnosticiranim gihtom. |
| Databáze: | OpenAIRE |
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