PMC5478570_01
A photograph of the bilateral hands and knees.
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The joints of the bilateral fingers and knees had rubor and swelling (Fig. 1).
a) A lateral radiograph of the right knee joint. b) Sagittal T1-weighted magnetic resonance imaging of the right knee joint.
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A plain radiograph of the right knee showed a punched-out lesion characterized by gouty tophi (Fig. 2a, arrows). T1-weighted magnetic resonance imaging (MRI) of the left knee, revealed that the nodule had a low signal intensity (Fig. 2b, asterisk), indicating bone erosion and destruction (Fig. 2b, arrows). His FEUA increased to 5.25% and his UA level decreased to 6.1 mg/dL after the use of benzbromarone (50 mg per day) (Fig. 5b and Table 2).
The histological examination of a punch biopsy specimen from the patient's right elbow. A representative Hematoxylin and Eosin staining section is shown.
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A needle biopsy specimen taken from his right elbow showed deposits of an amorphous material that consisted of urate crystals (Fig. 3, asterisk) surrounded by granulomatous inflammation (Fig. 3, arrows).
Whole body scintigraphy. a) 99mTc HMDP bone scintigraphy. b) Ga-67 citrate scintigraphy.
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99mTc HMDP bone scintigraphy showed severe accumulation in the joints of both knees and ankles and in the right elbow joint and the left second metacarpophalangeal joint. 99mTc HMDP bone scintigraphy also revealed moderate accumulation in both sternoclavicular and shoulder joints and the right carpometacarpal joint (Fig. 4a). Ga-67 citrate scintigraphy showed the abnormal accumulation in similar sites, which corresponded to the abnormalities on 99mTc HMDP bone scintigraphy (Fig. 4b).
A summary of the clinical course. a) The clinical course in the hospital. b) The clinical course in the overall treatment period.
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On the other hand, the renal clearance of uric acid (CUA) and the renal clearance of uric acid per creatinine clearance (fractional excretion of uric acid, FEUA) were reduced (CUA 1.91 to 4.15 mL/min, FEUA 1.72 to 2.28%, respectively) (Fig. 5a). Because of his renal calculi, treatment with a xanthine oxidase inhibitor (febuxostat, 10 mg per day) was initiated (Fig. 5a). His FEUA increased to 5.25% and his UA level decreased to 6.1 mg/dL after the use of benzbromarone (50 mg per day) (Fig. 5b and Table 2).