Pseudopodagra: A presenting manifestation of infective endocarditis

N. Boulman¹, G. Slobodin², D. Sharif³, M. Rozenbaum¹, I. Rosner¹

Department of Rheumatology¹, Internal Medicine A² and Cardiology Unit³, Bnai Zion Medical Center, Haifa, Israel.

ABSTRACT
Podagra is a term used to describe acute monoarthritis of the first metatarsophalangeal (1st MTP) joint. The most common diagnoses of arthritis in this joint are: crystal-induced synovitis, septic arthritis, traumatic conditions and reactive arthritis. When etiologies other than gout are involved this is frequently referred to as pseudopodagra. We report the case of a patient who presented with pain and swelling of the 1st MTP. The absence of intraarticular crystals and hyperuricemia encouraged further evaluation of the patient. A cardiac murmur was investigated by echocardiography, which revealed valvular vegetations and the diagnosis of infective endocarditis (IE) was established. This is the first reported case of a podagra-like presentation of IE. As in this case, the diagnosis of gout should rest on findings beyond the presence at 1st MTP arthritis, with evaluation of all extraarticular signs in order to rule out other possible diagnoses.

Key words
Pseudopodagra, acute monoarthritis, endocarditis.

Please address correspondence: Dr. Nina Boulman, Department of Rheumatology, Bnai Zion Medical Center, 47 Golomb St., P.O. Box 4940, Haifa 31048, Israel.
E-mail: rosneri@tx.technion.ac.il

Clin Exp Rheumatol 2005; 23: 251-253.
© CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2005.