Gout during pregnancy.

A 34-year-old woman, 12 weeks pregnant, presented with an acute monoarthritis. Gout was proven by joint aspiration. The gout was multifactorial in origin. Only 2 cases of gout during pregnancy have been described previously.

Experience at a referral center for patients with suspected Lyme disease in an area of nonendemicity: first 65 patients.

A multidisciplinary referral center was established at a university hospital for prospectively assessing patients with possible Lyme disease. Borrelia burgdorferi is not known to be endemic in this region, but considerable anxiety about Lyme disease has developed among the general public. Sixty-five patients were referred for suspected Lyme borreliosis. Detailed histories were obtained and physical examinations were performed; patients were investigated aggressively in accordance with their symptom complexes. Strict diagnostic criteria consistent with published standards were applied. Only two of the 65 patients were judged to have probable Lyme disease. Definite major alternate diagnoses were made for 50 patients (77%); firm medical diagnoses (11 dermatologic, 9 rheumatologic, 9 infectious disease, 6 gastrointestinal, 4 neurological, and 2 miscellaneous) were made for 41 patients (63%); and major psychiatric diagnoses were made for 9 patients (14%). Probable diagnoses of chronic fatigue syndrome and fibromyalgia were made for 11 patients (17%). The conditions of four patients (6%) were undiagnosed. A referral center for patients with suspected Lyme disease can be useful even in an area of nonendemicity, and careful clinical assessment will reveal treatable alternate diagnoses for many patients with suspected Lyme disease.