CASE REPORT

A 73 year old Polynesian woman was admitted with a 5 day history of severe pain in the right groin, right hip, and lower back and was unable to weight bear. Past history included tophaceous gout of 10 years’ duration, which was poorly controlled despite daily colchicine. She had chronic lymphoedema of the right leg (Milroy’s disease). This was complicated by recurrent episodes of right lower leg cellulitis requiring previous amputation of one of her toes due to intractable infection. She had a longstanding monoclonal gammopathy of uncertain significance. Other problems included hypertension, congestive cardiac failure, obesity, and impaired renal function (creatinine clearance 30 ml/min). Her drugs on admission were quinapril, furosemide, calcium carbonate, and paracetamol.

On examination she weighed 120 kg. A gouty tophus was present at the right index finger proximal interphalangeal joint. She was afebrile and normotensive. There was diffuse tenderness in the right groin and she was unable to actively lift the right leg owing to pain. Significant blood results …