(CS-046) The Rare Co-existence of Gout and Pseudogout within the Same Joint of the Foot

Kevin Vasquez-Monterroso, DPM – Resident physician, Podiatric Surgery, Yale New Haven Health - Bridgeport Hospital; Lady Paula DeJesus, DPM, FACFAS, CWSP – Physician, Podiatric surgery, Yale New Haven Health - Bridgeport Hospital

Introduction: Gout and pseudo-gout are common types of inflammatory diseases that affect the joints. As it is common to have one disease type present, it is rare to have a simultaneous occurrence of each condition within the same joint. This case study displays a rare occurrence of the presence of both gout and pseudogout within the same joint located in the foot with association of a non-healing wound.

Methods: 69 year old female presents with past medical history significant of gout and a chief complaint of right 2nd digit open wound present for more than 1 week. She reports that the wound started out a blister which popped, draining blood and purulence, along with gouty tophi. Patient had been treating wound with local wound care without success of closure of wound. Patient’s rheumatologist was managing gout with doxycycline 100mg, Uloric 40 mg, colchicine 0.6 mg daily and indomethacin sparingly. Wide sharp excisional debridement was performed to the 2nd digit wound with excision of gouty tophi. Specimen was sent to pathology. The area was flushed via pulse lavage. All nonviable tissue and tophi were excised and the wound was primarily closed with nylon.

Results: Pathology specimen of gouty tophi from associated wound resulted in both uric acid crystals (gout) as well as calcium pyrophosphate crystals (pseudogout). The wound healed 2 weeks postoperatively and sutures were removed without incident. No reoccurrence of wound was noted. Rheumatologist managed gout and pseudogout with Uloric 40 mg and colchicine 0.3 mg daily.

Discussion: The simultaneous presence of pseudogout and gout within the same joint is rare, however, it can occur. Given that the clinical symptoms of both gout and pseudogout may often appear identical, it is imperative that specimens be obtained to ensure proper treatment.