While gout is more common in older age, it can affect people of all ages. Polyarticular gout in younger people has been reported rarely in the medical literature (2). In a minority of patients, gout may present with complications of tophaceous deposits rather than acute arthritis (1). Dual energy CT (DECT) can be useful in the assessment of gout, but its precise role in diagnosis and treatment monitoring is still evolving (3).
A 20 year old man presented to the orthopaedic hand clinic with a 3 month history of dactylitis of the ring finger. The patient had a relevant past medical history of recurrent renal calculi and previous inflammatory oligoarthritis affecting both ankles. He had no other relevant metabolic risk factors, and his body mass index was 20. He had no family history of gout.
Surgical debridement was undertaken, and tophaceous material identified. A serum urate was measured to be 0.68 mmol/L. The presence of monosodium urate crystals was confirmed using polarised light microscopy. DECT of the affected hand was performed and was consistent with extensive urate deposition. Urate lowering therapy was commenced and ultimately the level fell to 0.19 mmol/L with the combination of allopurinol 900mg daily and probenecid 1000mg twice daily.
Serial dual energy CT showed a significant reduction of urate burden.
This case illustrates an unusual presentation of gout in a young person, and the role dual energy CT can play in the monitoring of gout and confirming response to urate lowering therapy, particularly in unusual presentations. Illustrative DECT images will be displayed.