Clinical factors and treatment outcomes associated with failure in the detection of urate crystal in patients with acute gouty arthritis

BACKGROUND/AIMS: To investigate the rate of detection of monosodium urate (MSU) crystals in the synovial fluid (SF) of patients with acute gouty arthritis and factors associated with false-negative results. METHODS: A total of 179 patients with acute gouty arthritis who had undergone SF crystal examination were identified from the data warehouse of two university hospitals. Clinical and laboratory data were obtained from the medical records. RESULTS: The overall rate of detection of MSU crystals was 78.8%. In univariate analyses, the only significant differences between the variables of crystal-negative and crystal-positive patients were a lower C-reactive protein level (p = 0.040) and fewer patients undergoing emergent surgery in the crystal-positive group (p = 4.5 x 10(-6)). In logistic regression analyses, MSU crystal-negative results were significantly associated with the interval from arthritis onset to crystal examination (p = 0.042), and this was the most significant risk factor for arthroscopic surgery (p = 2.1 x 10(-4)). Seventeen patients who underwent arthroscopic surgery had a significantly longer hospital stay (p = 0.007) and a significant delay in gout treatment (p = 8.74 x 10(-5)). The distribution of crystal-negative patients differed significantly between the SF samples that were evaluated by both the laboratory medicine and the rheumatology departments (p = 1.2 x 10(-14)), and the kappa value was 0.108. CONCLUSIONS: Although several clinical features were associated with detection failure, SF MSU crystal identification was critically dependent on the observer. Considering the impact on the treatment outcomes, implementation of a quality control program is essential.

A Case of Sudden Sensorineural Hearing Loss in a Patient with Axial Spondyloarthritis

Sudden sensorineural hearing loss (SNHL) is rarely presented in patients with several immune-mediated inflammatory diseases. We report a case of sudden SNHL in a patient with axial spondyloarthritis (aSpA). A 29-year-old male with aSpA was admitted for sudden unilateral hearing loss. His aSpA symptom was stable; however, pure tone audiometry revealed that he had SNHL in the left ear at low frequency. His hearing was fully recovered with systemic and local steroid therapy. This case suggests that sudden SNHL may be an extra-articular manifestation of aSpA and thus need prompt steroid therapy in order to restore hearing.

A Case of Central Nervous System Actinomycosis Presenting as Brain Abscess

Actinomyces normally colonizes the mouth, colon, and vagina. Although disruption of mucosa may lead to infection at virtually any site, central nervous system actinomycosis is rare. A 45-year-old man presented with seizure and magnetic resonance imaging showed brain abscess. He was diagnosed with actinomycotic and streptococcal infection of brain by histologic and microbiologic examination. After stereotactic aspiration and biopsy, he was treated successfully by prolonged antibiotic therapy using intravenous penicillin-G and oral amoxicillin.

A Case of Syphilitic Uveitis in an Immunocompetent Patient

Syphilis is re-emerging worldwide due to the HIV epidemic. Prior to the introduction of penicillin, syphilis was the second most common primary cause of all cases of uveitis. Today, ocular syphilis is a rare disease, especially in an immunocompetent patient. Variable manifestation without pathognomonic signs of ocular syphilis often lead to delayed diagnosis, resulted in irreversibile loss of vision. In Korea, syphilitic uveitis has not been reported in an immunocompetent patient since 1984. We experienced a case of syphilitic uveitis in an immunocompetent man with visual deterioration. As the incidence of syphilis is increasing in these days, a high degree of clinical suspicion should be considered in patients with unexplained ocular inflammation and visual disturbances.

A Case of Central Nervous System Actinomycosis Presenting as Brain Abscess

Actinomyces normally colonizes the mouth, colon, and vagina. Although disruption of mucosa may lead to infection at virtually any site, central nervous system actinomycosis is rare. A 45-year-old man presented with seizure and magnetic resonance imaging showed brain abscess. He was diagnosed with actinomycotic and streptococcal infection of brain by histologic and microbiologic examination. After stereotactic aspiration and biopsy, he was treated successfully by prolonged antibiotic therapy using intravenous penicillin-G and oral amoxicillin.

A Case of Syphilitic Uveitis in an Immunocompetent Patient

Syphilis is re-emerging worldwide due to the HIV epidemic. Prior to the introduction of penicillin, syphilis was the second most common primary cause of all cases of uveitis. Today, ocular syphilis is a rare disease, especially in an immunocompetent patient. Variable manifestation without pathognomonic signs of ocular syphilis often lead to delayed diagnosis, resulted in irreversibile loss of vision. In Korea, syphilitic uveitis has not been reported in an immunocompetent patient since 1984. We experienced a case of syphilitic uveitis in an immunocompetent man with visual deterioration. As the incidence of syphilis is increasing in these days, a high degree of clinical suspicion should be considered in patients with unexplained ocular inflammation and visual disturbances.

Inferior Sinus Venosus Type Atrial Septal Defect Initially Presenting Pulmonary Hypertension on Transthoracic Echocardiography

Inferior sinus venosus type atrial septal defect (ASD) is a rare congenital cardiac deformity that occurs between the inferior vena cava and right atrium. Inferior sinus venosus defect is difficult to diagnose through transthoracic echocardiography because of its location which is infero-posterior to the fossa ovalis. Increasing pulmonary arterial pressure and pulmonary vascular resistance in patients with sinus venosus defect usually occur earlier than other types of ASD. We report a case of 19-year-old man who presented exertional dyspnea due to inferior sinus venous type ASD with mild pulmonary hypertension. In this case, we found clues from slight diastolic flattening of interventricular septum and shortened acceleration time of right ventricular outflow tract on initial transthoracic echocardiography, leading right heart catheterization and transesophageal echocardiography to reveal this rare type of ASD.