Coincident gout and bacterial infection

: A 57-year-old female patient with a history of tophaceous gout based on chronic renal insufficiency caused by systemic lupus erythematosus nephritis developed bursitis of the right lateral malleolus. This was taken for gout and was treated with colchicine and an increased dose of her maintenance therapy of oral glucocorticoids. Since this had no effect, a local diagnostic puncture was performed. Aspiration yielded pus from which Staphylococcus aureus was cultured; upon polarisation microscopy many uric acid crystals were seen. The diagnosis was gout and coincident bacterial infection. Therapy consisted of incision of the bursa and antibiotic therapy. Local recovery was uneventful. In patients suspected of an acute gout attack who have an increased risk of bacterial infection, e.g. elderly and patients with severe comorbidity or immunodeficiency, a local diagnostic aspiration is the only adequate investigation. Only if (coincident) bacterial infection has been ruled out, patients with contraindications for non-steroidal anti-inflammatory drug therapy and colchicine may safely be treated for a gout attack with oral glucocorticoids.