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  • Case Study
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Successful treatment with rasburicase of a tophaceous gout in a patient allergic to allopurinol

Nature Clinical Practice Rheumatology volume 2, pages 338–342 (2006)Cite this article

Abstract

Background A 56-year-old white woman was referred to our institution with a 16-month history of severe, gouty, recurrent, acute polyarthritis involving the finger joints. She also had numerous small subcutaneous tophi in her hands. The patient was intolerant to allopurinol and had mild renal insufficiency attributed to uric-acid nephrolithiasis and interstitial nephropathy.

Investigations Physical examination, laboratory testing, X-rays of the hands, feet and pelvis, CT of the pelvis, microscopic analysis of an aspirate from a finger tophus.

Diagnosis Tophaceous gout associated with urate nephropathy in a patient intolerant to allopurinol.

Management Acute polyarthritis was successfully managed by intravenous bolus methylprednisolone combined with codeine, diclofenac and low-dose colchicine. Rasburicase infusions combined with fenofibrate and sodium bicarbonate achieved to maintain serum acid uric below 360 µmol/l.

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Figure 1: Microscopic analysis of an aspirate from a tophus.
Figure 2: Course of serum uric-acid levels during long-term rasburicase treatment.
Figure 3: Drugs affecting urate levels and their underlying mechanisms.

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Acknowledgements

Written consent was obtained from the patient reported in this Case Study. We thank Dr K Ea for providing photos of monosodium urate crystals detected by compensated polarized-light microscopy.

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Authors and Affiliations

  1. a Rheumatologist,

    Pascal Richette

  2. a Professor of Rheumatology at the department of Rheumatology, Centre Viggo Petersen, Lariboisiere Hospital, University Paris VII, France

    Thomas Bardin

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  1. Pascal Richette
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  2. Thomas Bardin
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Correspondence to Pascal Richette.

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Competing interests

Pascal Richette declared he has no competing interests. Thomas Bardin has declared he is a consultant for Ipsen.

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Richette, P., Bardin, T. Successful treatment with rasburicase of a tophaceous gout in a patient allergic to allopurinol. Nat Rev Rheumatol 2, 338–342 (2006). https://doi.org/10.1038/ncprheum0214

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