Article

Extra-articular manifestations of gout can present in several ways, including
tenosynovitis. We present a rare case of acute tibialis posterior gouty
tenosynovitis. An 82-year-old man with a history of well-controlled gout
presented with acute onset of left ankle pain, occurring without inciting event.
The medial ankle was slightly erythematous with moderate dorsal-medial swelling
and mild dorsal-lateral swelling, with severe tenderness to palpation over the
medial retro-malleolar region. Range of motion and manual muscle testing were
pain limited throughout. Ultrasound examination revealed a left posterior
tibialis tendon sheath tenosynovitis with effusion and overlying soft tissue
edema. Tendon sheath aspirate revealed sodium urate crystals and a white blood
cell count of 6400/muL.
Tendon sheath injection with a mixture of 1% lidocaine
and dexamethasone 4 mg resulted in symptom resolution. Repeat ultrasound
examination demonstrated no evidence of tibialis posterior tendon sheath
effusion. This case is unique not only because acute gouty posterior tibialis
tenosynovitis is very rare, particularly in a normouricemic individual, but also
because the sonographic evidence of gouty infiltration into the posterior
tibialis tendon and overlying subcutaneous tissue considerably aided in arriving
at the correct diagnosis in a timely manner.

Langue : ANGLAIS