Infectious Complications in a Patient Receiving Immunomodulatory Therapy for Gout

TL;DR

A 75-year-old woman with gout and comorbidities developed a severe infection while on immunomodulatory therapy, highlighting the need for careful monitoring.

Contribution

This case report highlights the risk of opportunistic infections in gout patients on immunomodulatory therapy.

Findings

The patient developed MRSA bacteremia and pelvic osteomyelitis during treatment.

The patient recovered but has a persistent wound with no signs of active infection.

The case underscores the need for infection risk assessment and multidisciplinary care.

Abstract

Pegloticase is a recombinant uricase enzyme used in the treatment of refractory and severe tophaceous gout, often administered in combination with an immunomodulator such as mycophenolate mofetil and accompanied by pre-infusion medications, including corticosteroids and antihistamines to reduce hypersensitivity reactions. While this regimen is effective for managing gout, it may also increase the risk of opportunistic infections, particularly in patients with significant comorbidities. We present the case of a 75-year-old female patient with multiple comorbidities, including diabetes and chronic kidney disease, who developed a significant gluteal abscess that progressed to pelvic osteomyelitis and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia while undergoing treatment for refractory gout with pegloticase (Krystexxa) and mycophenolate mofetil (CellCept). The patient has recovered from the infection; however, a 2.5 × 1.5 × 7.3 cm wound persists. The wound has remained clean with healthy granulation tissue and no exposed bone or signs of an active infection. This case highlights the importance of assessing infection risk in patients receiving immunomodulatory treatments for gout and demonstrates the need for close monitoring and multidisciplinary care, particularly in those with underlying comorbidities.

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