Disclosures: Shrut Patel, MD: Nothing to disclose

Case Description: The patient is a 52-year-old male who presented to the clinic for conservative management of known right knee osteoarthritis. Point-of-care diagnostic ultrasonography demonstrated a moderate effusion in the suprapatellar recess and degenerative changes of the tibiofemoral joint. By history, the patient responded favorably to a prior single intra-articular viscosupplementation injection, and in consideration of this, the injection was repeated. Post-injection, the patient developed progressive swelling and heaviness of the right knee without constitutional signs of infection concerning for pseudoseptic reaction. Sixty-five milliliters of fluid were aspirated and sent for analysis. At that time the patient revealed a prior, unreported, history of gout that historically affected his right elbow and wrist.

Setting: Academic Outpatient Sports Medicine Clinic

Patient: 52-year-old male presents with right knee pain.

Assessment/Results: Right knee joint fluid analysis demonstrated monosodium urate crystals. He was prescribed indomethacin for the treatment of gout and referred to rheumatology. His symptoms did improve.

Discussion: The prevalence of gout has steadily increased in the United States and currently affects approximately 3-8 million adults according to literature. The majority of gout flares typically occur at the base of the hallux or the knee in the setting of common risk factors including genetics and family history, dietary and alcoholic consumption, diuretic use, and renal insufficiency. This case describes an atypical presentation of gout disguising as a pseudoseptic reaction following viscosupplementation injection.

Conclusion: The differential for joint swelling post-viscosupplementation should remain broad and include crystal arthropathies. During these cases, joint fluid analysis is helpful in narrowing the diagnosis for conclusive treatment.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/atypical-presentation-of-gout-disguised-as-pseudoseptic-reaction-following-viscosupplementation-injection-a-case-report/