J Rheum Dis 2017; 24(4): 246-250  
Multifocal Osteonecrosis in a Patient with Gout: Case Report and Review of the Literature
Sang-woo Kang, Chang-hoon Lee
Division of Rheumatology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
Correspondence to: Chang-hoon Lee, Division of Rheumatology, Department of Internal Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Korea. E-mail:lch110@wonkwang.ac.kr
Received: February 15, 2017; Revised: March 20, 2017; Accepted: March 26, 2017; Published online: August 31, 2017.
© Korean College of Rheumatology. All rights reserved.

This is a open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Osteonecrosis (ON) is a common comorbidity in gout; however, avascular ON of multiple sites is unusual. Multifocal ON is defined as osteonecrotic lesions affecting three or more separate anatomic sites. We report a case of a 31-year-old woman diagnosed with gout, who had multifocal ON. Initially, she was treated with benzbromarone, colchicine, and meloxicam. Two years later, she developed severe tophi and was diagnosed with chronic renal failure. Magnetic resonance imaging (MRI) of both legs revealed bilateral ON of the femoral head. She underwent bilateral hip replacement surgeries. After two years, she had pain and limited movements in the left shoulder, with tophi identified via dual-energy computed tomography. Despite management with non-steroidal anti-inflammatory drugs, colchicine, and prednisolone, she had persistent shoulder pain. MRI of the left shoulder revealed ON. She therefore underwent left shoulder replacement surgery. Following the case report, we review the literature on multifocal ON with gout.
Keywords: Osteonecrosis, Multiple, Gout


This Article

e-submission

Archives