Staub-Zähner Tanja, Garzoni Daniela, Fretz Christian, Lampert Christoph, Ohlschlegel Christian, Wüthrich Rudolf P, Fehr Thomas
Kantonsspital, St Gallen, Switzerland.
Nat Clin Pract Nephrol. 2007 Jun;3(6):345-9. doi: 10.1038/ncpneph0494.
A 33-year-old renal transplant recipient presented with painless swelling of the right knee. Physical examination revealed an impressive knee joint effusion with no signs of inflammation. The patient did not remember a recent trauma, but he mentioned a strain 3 years earlier; radiographic findings had been normal at that time. The patient had suffered from end-stage renal disease due to chronic glomerulonephritis and had previously undergone two transplantations. At presentation, his kidney function was stable under treatment with ciclosporin, azathioprine and steroids.
Conventional radiography revealed a tumor at the superolateral pole of the right patella. Extensive soft tissue invasion and bone destruction was seen on MRI. A knee arthroscopy with biopsy, performed to aid diagnosis, showed extensive chondrocalcinosis macroscopically; histologically, gouty tophi were found.
Pseudotumor of gout in the patella.
Uric-acid-lowering therapy with benzbromarone was started immediately after diagnosis. A local arthroscopic debridement of the right knee joint was performed 4 months later, and the patient remained asymptomatic for the next 3 years.
一名33岁的肾移植受者出现右膝无痛性肿胀。体格检查发现膝关节有明显积液，无炎症迹象。患者不记得近期有过外伤，但提到3年前有过拉伤；当时的影像学检查结果正常。该患者因慢性肾小球肾炎患有终末期肾病，此前已接受过两次移植手术。就诊时，他在环孢素、硫唑嘌呤和类固醇治疗下肾功能稳定。
传统X线检查显示右髌骨上极有一个肿瘤。MRI显示有广泛的软组织侵犯和骨质破坏。为辅助诊断进行的膝关节镜检查及活检显示，肉眼可见广泛的软骨钙质沉着；组织学检查发现痛风石。
髌骨痛风性假肿瘤。
诊断后立即开始使用苯溴马隆进行降尿酸治疗。4个月后对右膝关节进行了局部关节镜清创术，患者在接下来的3年里一直无症状。
