© 2004 by BMJ Publishing Group Ltd & European League Against Rheumatism
LESSON OF THE MONTH
Tophaceous gout of the pubic symphysis: an unusual cause of groin pain
Series editor: Anthony D Woolf
Department of Rheumatology, Auckland City Hospital, New Zealand
Correspondence to:
Correspondence to:
Associate Professor F McQueen
Department of Rheumatology, Building 7, Auckland Hospital, Private Bag 92024, Auckland Healthcare Services Ltd, New Zealand; f.mcqueen@auckland.ac.nz
Accepted 21 January 2004
Keywords: magnetic resonance imaging; gout; pubic symphysis; tophi
| The first 150 words of the full text of this article appear below. |
A 73 year old Polynesian woman was admitted with a 5 day history of severe pain in the right groin, right hip, and lower back and was unable to weight bear. Past history included tophaceous gout of 10 years’ duration, which was poorly controlled despite daily colchicine. She had chronic lymphoedema of the right leg (Milroy’s disease). This was complicated by recurrent episodes of right lower leg cellulitis requiring previous amputation of one of her toes due to intractable infection. She had a longstanding monoclonal gammopathy of uncertain significance. Other problems included hypertension, congestive cardiac failure, obesity, and impaired renal function (creatinine clearance 30 ml/min). Her drugs on admission were quinapril, furosemide, calcium carbonate, and paracetamol.
On examination she weighed 120 kg. A gouty tophus was present at the right index finger proximal interphalangeal joint. She was afebrile and normotensive. There was diffuse tenderness in the right groin and she
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