Skedros John G, Smith James S, Henrie Marshall K, Finlinson Ethan D, Trachtenberg Joel D
Department of Orthopaedic Surgery and Utah Orthopaedic Specialists, The University of Utah, 5323 South Woodrow Street, Salt Lake City, UT 84107, USA.
St. Marks Hospital, Salt Lake City, UT, USA.
Case Rep Orthop. 2018 Jan 23;2018:3204714. doi: 10.1155/2018/3204714. eCollection 2018.
We report the case of a 30-year-old Polynesian male with a severe gout flare of multiple joints and simultaneous acute compartment syndrome (ACS) of his right forearm and hand without trauma or other typical causes. He had a long history of gout flares, but none were known to be associated with compartment syndrome. He also had concurrent infections in his right elbow joint and olecranon bursa. A few days prior to this episode of ACS, high pain and swelling occurred in his right upper extremity after a minimal workout with light weights. A similar episode occurred seven months prior and was attributed to a gout flare. Unlike past flares that resolved with colchicine and/or anti-inflammatory medications, his current upper extremity pain/swelling worsened and became severe. Hand and forearm fasciotomies were performed. Workup included general medicine, rheumatology and infectious disease consultations, myriad blood tests, and imaging studies including Doppler ultrasound and CT angiography. Additional clinical history suggested that he had previously unrecognized recurrent exertional compartment syndrome that led to the episode of ACS reported here. Chronic exertional compartment syndrome (CECS) presents a difficult diagnosis when presented with multiple symptoms concurrently. This case provides an example of one such diagnosis.
我们报告了一例30岁的波利尼西亚男性病例，该患者出现多个关节的严重痛风发作，同时右前臂和手部出现急性骨筋膜室综合征（ACS），且无创伤或其他典型病因。他有长期痛风发作史，但此前均未发现与骨筋膜室综合征相关。他的右肘关节和鹰嘴滑囊同时存在感染。在这次ACS发作前几天，他进行了少量轻重量锻炼后，右上肢出现高度疼痛和肿胀。七个月前曾发生过类似情况，当时归因于痛风发作。与过去用秋水仙碱和/或抗炎药物治疗后缓解的发作不同，他目前上肢的疼痛/肿胀加剧并变得严重。遂进行了手部和前臂筋膜切开术。检查包括普通内科、风湿病学和传染病会诊、大量血液检查以及包括多普勒超声和CT血管造影在内的影像学检查。进一步的临床病史提示，他此前存在未被识别的复发性运动性骨筋膜室综合征，导致了此处报告的ACS发作。当同时出现多种症状时，慢性运动性骨筋膜室综合征（CECS）的诊断具有挑战性。本病例提供了一个此类诊断的实例。
