血清尿酸正常的痛风

A case of gout with normal serum uric acid

患者女,85岁。右前臂肿痛2个月。外院拟诊“丹毒?”予抗感染治疗效果欠佳。皮肤科检查:右手腕关节及手背肿胀明显,皮温升高,伴轻度压痛,皮肤表面无溃疡。实验室检查:血清尿酸水平正常。皮损组织病理:表皮角化过度,真皮水肿和纤维组织增生,伴淋巴细胞和浆细胞浸润,PAS染色、抗酸染色及阿新蓝染色均阴性。双能量CT(DECT)检查右腕关节周围可见痛风石沉积。诊断:痛风。经秋水仙碱联合塞来昔布治疗后病情好转。

An 85-year-old female patient presented with swelling and pain in her right forearm for 2 months.The initial diagnosis of“erysipelas”was made in a foreign hospital,and the effect of anti-infective treatment was not good.The patient then visited our hospital for further treatment.Dermatological examination showed obvious swelling in the right wrist joint and the back of the hand,elevated skin temperature accompanied by mild tenderness,and undamaged skin surface.Lab examination demonstrated normal serum uric acid level.Skin pathology showed epidermal hyperkeratosis,dermal edema and fibrous tissue hyperplasia,together with lymphocyte and plasma cell infiltration.PAS staining,acid-fast staining,axin blue staining were all negative.Dual-energy computed tomography(DECT)of the right hand revealed tophi deposits around the wrist.Diagnosis:gout.Her condition was improved after treatment of colchicine combined with celecoxib.