SHM Converge Scientific Abstract ePoster Gallery-Avoiding a Knee-Jerk Diagnosis

Pdf Summary

A 64-year-old woman with hemoglobin-SS sickle cell disease, prior avascular necrosis, and stroke was admitted with acute confusion, right-sided weakness, and left leg pain. Initial neuroimaging showed no acute stroke. She later developed opioid-induced hypercarbic respiratory failure, improved, and returned to the floor. Her persistent leg and knee pain was initially attributed to vaso-occlusive crisis, but by hospital day 13 she developed bilateral knee swelling. Because she reported a prior history of gout, clinicians performed ultrasound-guided arthrocentesis of the right knee, which showed monosodium urate crystals, confirming gout. She was treated with prednisone, anakinra, allopurinol, and colchicine, with significant improvement and discharge home.<br /><br />The case highlights that osteoarticular complications of sickle cell disease include not only vaso-occlusive crises and avascular necrosis, but also gout, which may be underrecognized. Literature suggests gout is more common in patients with sickle cell disease than in matched controls. Risk may be higher in those with HbSS, elevated uric acid, anemia, and poor renal function. Diagnosis can be difficult because joint pain may be misattributed to sickle cell pain or prior musculoskeletal disease. The authors emphasize that clinicians should maintain suspicion for gout in sickle cell patients with joint pain, especially when there is joint effusion, hyperuricemia, or renal dysfunction.

Asset Subtitle

John R. Stephens

Meta Tag

Author List David Hemsey, James Rogers, John R. Stephens, Will Rearick

Category Clinical Vignettes

Concept Sickle Cell Disease

Concept Vaso-occlusive Pain

Concept Gout

Concept Avascular Necrosis

Concept Arthrocentesis

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author John R. Stephens

Track Adult

Keywords

sickle cell disease

hemoglobin SS

gout

monosodium urate crystals

arthrocentesis

joint pain

avascular necrosis

vaso-occlusive crisis

hyperuricemia

anakinra

Sickle Cell Disease

Vaso-occlusive Pain

Gout

Avascular Necrosis

Arthrocentesis