# Coexistent gouty and infectious tenosynovitis in the hand: a case report and narrative review of comparable cases

## TL;DR

A rare case of gout and infection in the hand led to severe complications requiring amputation, highlighting the need for early diagnosis and aggressive treatment.

## Contribution

This case report adds to the limited literature on coexisting gouty and infectious tenosynovitis in the hand.

## Key findings

- Coexisting gout and infection in the hand can lead to severe tissue damage if misdiagnosed.
- Standard treatments may fail in cases of combined gout and infection, necessitating surgical intervention.
- Serum uric acid levels may be normal in complicated gout cases, emphasizing the need for synovial fluid analysis.

## Abstract

Although less commonly in the hand, gouty tenosynovitis may present with symptoms resembling infection. Only a few case reports document such presentations, and reports of coexisting infection and gouty tenosynovitis are even more uncommon. A 32-year-old male with polyarticular tophaceous gout, noncompliant with medications, presented with a one-day history of right index finger swelling and redness. Investigations were suggestive of infectiousious tophus. Despite broad-spectrum antibiotics and rheumatologic interventions (colchicine, allopurinol, and corticosteroids), his condition deteriorated. Multiple incisions and drainages were performed without improvement. Persistent infection, confirmed to be methicillin-resistant Staphylococcus aureus (MRSA), complicated the underlying gouty inflammation. Standard therapies for infective tenosynovitis did not yield clinical resolution, presumably due to ongoing crystal-induced inflammation and compromised tissue. Ultimately, finger amputation was performed to control disease progression after all other salvage options failed. This case underscores the aggressive and destructive potential of gout when complicated by infection. Normal or relatively low serum uric acid levels do not exclude gout, and synovial fluid crystal analysis can be pivotal. Coexisting infection and gouty tenosynovitis in the hand can lead to severe tissue damage if misdiagnosed or inadequately treated. A high index of suspicion, multidisciplinary collaboration, and timely surgical intervention are crucial in preventing further morbidity. This case demonstrates that amputation may be necessary when infection remains unresponsive to standard treatments, emphasizing the importance of early diagnosis and aggressive management.