Jacobs Johannes W G, van Reekum Franka
Universitair Medisch Centrum Utrecht, Afd. Reumatologie en Klinische Immunologie, Utrecht, the Netherlands.
Ned Tijdschr Geneeskd. 2010;154:A2141.
A 57-year-old female patient with a history of tophaceous gout based on chronic renal insufficiency caused by systemic lupus erythematosus nephritis developed bursitis of the right lateral malleolus. This was taken for gout and was treated with colchicine and an increased dose of her maintenance therapy of oral glucocorticoids. Since this had no effect, a local diagnostic puncture was performed. Aspiration yielded pus from which Staphylococcus aureus was cultured; upon polarisation microscopy many uric acid crystals were seen. The diagnosis was gout and coincident bacterial infection. Therapy consisted of incision of the bursa and antibiotic therapy. Local recovery was uneventful. In patients suspected of an acute gout attack who have an increased risk of bacterial infection, e.g. elderly and patients with severe comorbidity or immunodeficiency, a local diagnostic aspiration is the only adequate investigation. Only if (coincident) bacterial infection has been ruled out, patients with contraindications for non-steroidal anti-inflammatory drug therapy and colchicine may safely be treated for a gout attack with oral glucocorticoids.
一名57岁女性患者，有痛风石性痛风病史，基础疾病为系统性红斑狼疮肾炎所致慢性肾功能不全，现出现右外踝滑囊炎。起初考虑为痛风，给予秋水仙碱及增加口服糖皮质激素维持治疗剂量。因治疗无效，遂行局部诊断性穿刺。抽出物为脓液，培养出金黄色葡萄球菌；偏振光显微镜检查可见许多尿酸盐结晶。诊断为痛风合并细菌感染。治疗包括滑囊切开引流及抗生素治疗。局部恢复顺利。对于怀疑急性痛风发作且有细菌感染风险增加的患者，如老年人、合并严重疾病或免疫缺陷患者，局部诊断性穿刺抽吸是唯一合适的检查方法。只有在排除（合并的）细菌感染后，有非甾体抗炎药治疗和秋水仙碱禁忌证的患者，才可以安全地使用口服糖皮质激素治疗痛风发作。
