Lee DY, Eo S, Lim S, Yoon JS. Gouty tenosynovitis with compartment syndrome in the hand: A case report. World J Clin Cases 2023; 11(30): 7492-7496 [PMID: 37969458 DOI: 10.12998/wjcc.v11.i30.7492]
Corresponding Author of This Article
Jung Soo Yoon, MD, PhD, Doctor, Professor, Surgeon, Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, 27, Dongguk-ro, Ilsandong-gu, GoYang 10326, South Korea. crsboys@naver.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 26, 2023; 11(30): 7492-7496 Published online Oct 26, 2023. doi: 10.12998/wjcc.v11.i30.7492
Gouty tenosynovitis with compartment syndrome in the hand: A case report
Dong Yun Lee, SuRak Eo, SooA Lim, Jung Soo Yoon
Dong Yun Lee, SuRak Eo, SooA Lim, Jung Soo Yoon, Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, GoYang 10326, South Korea
Author contributions: Lee DY, Eo SR, Lim SA and Yoon JS designed the clinical case report; Lee DY, Eo SR and Yoon JS analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript.
Informed consent statement: This study was approved by the Institutional Review Board (IRB) of the Clinical Research Coordinating Center (Samsung Medical Center, Seoul, Republic of Korea). This study was conducted in accordance with the Declaration of Helsinki, as revised in 2013. The primary version of the consent form signed by the patient is attached as a separate file. Consent for participation and publication was obtained from the patient.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jung Soo Yoon, MD, PhD, Doctor, Professor, Surgeon, Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, 27, Dongguk-ro, Ilsandong-gu, GoYang 10326, South Korea. crsboys@naver.com
Received: August 4, 2023 Peer-review started: August 4, 2023 First decision: September 19, 2023 Revised: October 6, 2023 Accepted: October 16, 2023 Article in press: October 16, 2023 Published online: October 26, 2023 Processing time: 81 Days and 21.4 Hours
Abstract
BACKGROUND
Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues. It typically appears with abrupt and intense pain, redness, and swelling in the affected joint. It frequently targets the lower extremities, such as the big toe. However, rarely, gout can manifest in atypical locations, including the hands, leading to an uncommon presentation known as gouty tenosynovitis. However, it can result in significant morbidity owing to the potential for severe complications, such as myonecrosis and compartment syndrome.
CASE SUMMARY
An 82-year-old male patient with a history of hypertension, cerebral infarction, Parkinson's disease, and recurrent gout attacks sought medical attention because of progressive pain and swelling in the right hand. Imaging findings revealed forearm swelling, raising concerns of possible tenosynovitis, bursitis, septic arthritis, and compartment syndrome. A fasciotomy was performed to decompress the patient’s hands and forearms. The procedure revealed diffuse tenosynovitis, tophi with a pus-like discharge surrounding the carpal tunnel, and involvement of the flexor and extensor tendon sheaths. However, microbiological investigations, including Gram staining, acid-fast bacilli, tuberculosis, and non-tuberculous mycobacteria, yielded negative results. The patient was ultimately diagnosed with a severe gouty attack with compartment syndrome and myonecrosis. Septic arthritis and infectious flexor tenosynovitis were ruled out. Serial debridement and inflammation control were initiated, followed by staged closure with a skin graft.
CONCLUSION
Septic-like complications can occur in the absence of infection in severe gout attacks with pus-like discharges due to compartment syndrome and myonecrosis. Cultures can be used to differentiate between gouty attacks, septic arthritis, and infectious tenosynovitis. Involvement of the flexor and extensor muscles, as in this case, is rare. This study contributes to the literature by reporting a rare case of successful fasciotomy and serial debridement in an elderly patient with multiple comorbidities.
Core Tip: This study reports three novel findings, which may contribute to the existing literature. First, there was an uncommon lesion in an area that was different from the usual site of a gout attack. Second, the gout attack was severe enough to cause compartment syndrome. Third, it was a very rare case involving the flexor and extensor tendons. The successful management of elderly patients highlights the importance of prompt recognition, interdisciplinary collaboration, and tailored treatment strategies for optimal patient outcomes.
