[Combination of ankylosing spondylitis with dermatomyositis and atypical gout (isolated gout kidney)].

In a 58-year-old man with the clinical and radiological signs of definite ankylosing spondylitis in its final stages, HLA B 27 positive, an onset of dermatomyositis was observed with characteristic clinical, histological, and pathological findings, and with high titers of ANA. It had been discovered years before that a gouty kidney with pyelonephritis accompanied the advanced ankylosing spondylitis. On the basis of these findings a triple association of etiologically different diseases could be diagnosed. After treatment with cortisone, allopurinol, and azathioprine appeared an acute and no longer controllable panmyelophthisis. That a malignant tumor could have caused the dermatomyositis was excluded by autopsy. Diagnostic questions concerning the gouty kidney as well as factors explaining the acute and deadly progress of a panmyelophthisis after the administration of a rather mild immunosuppressive agent are discussed.