Case Report of Gouty Arthritis Complicated by Septic Arthritis

Gouty knee arthritis shares numerous clinical similarities with septic knee arthritis. Core overlapping manifestations include sudden onset of unilateral knee symptoms such as redness, swelling, heat, and pain, accompanied by significant functional impairment and restricted mobility. Inflammatory markers like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are often markedly elevated in both conditions. Early imaging studies typically fail to reveal bone destruction. Due to highly overlapping clinical presentations, misdiagnosis between the two conditions is common, often requiring joint aspiration and synovial fluid analysis for definitive diagnosis. This report describes a case of gouty arthritis complicated by suppurative arthritis. The patient presented with a sudden onset of swelling and pain in the right knee lasting 2 days, accompanied by increased skin temperature and limited mobility. The patient had no prior history of gout and was otherwise in good health. Routine synovial fluid analysis showed a white blood cell count of 4+ and a red blood cell count of 1+. Culture identified Staphylococcus aureus (MRSA) in the sample. After vancomycin treatment, symptoms significantly improved, and the patient was discharged 1 week later. However, 2 days post-discharge, the patient returned with recurrent knee swelling and pain. Following a multidisciplinary consultation, arthroscopic debridement was performed. Intraoperative findings revealed extensive chalky crystal deposits within the joint cavity. Postoperative pathology confirmed gouty arthritis. The patient was discharged after symptom resolution following postoperative allopurinol therapy to reduce uric acid levels. This case underscores the importance of early differentiation between gouty arthritis and septic arthritis in clinical practice, as well as the necessity of scientific management.