A 32-year-old male, born in Pakistan, with no personal history of interest, came to the consultation for pain and inflammation in the internal face of the left ankle, which has also added pain in the right internal foot, predominantly ankle.
The difficulty in walking led him to go to the emergency department before, where fever of 38.1oC was observed and the laboratory tests requested in this service showed high acute phase reactants (CRP 116 and leukocytosis).
It may be of interest that the patient travels to his home country a month before.
Physical examination revealed edema in the area of internal malleolus, with increased temperature and erythema.
After treatment with conservative treatment of the left hand (uprofen 600 mg) for one week, there is some improvement in ankle pain although there has been inflammation in the interphalangeal joint of the first toe of the left foot and signs of the latter inflammatory pain.
Keeps good general condition.
Acute phase reactants (PCR 87, VSG 57) remained elevated in the laboratory tests ordered. Anemia and alterations in autoimmunity (ANA 2,610) and antinuclear acid antibodies were observed.
This picture, recurrent migratory polyarthritis along with cutaneous eruption, suggests a possible reactive arthritis, so she is referred to the rheumatology service in order to consider the etiology of the condition and the possible treatment.
After evaluation by the rheumatologist, she was diagnosed with gouty arthritis.
A history of recurrent monoarthritis may indicate the diagnosis previously mentioned.
However, in the presence of acute polyarthritis, it is initially not suggestive that it is a microcrystalline arthritis.
Treatment with colchicine and allopurinol was prescribed, without further improvement of the initial symptoms.
The patient also reported worsening of his general condition with sweating and weight loss of about 20 kg since the onset of symptoms, without loss of appetite or other symptoms in the anamnesis by devices.
In addition, migratory joint pains persist without inflammatory signs.
4 mg/ml.
Serological studies for HIV, Lyme, Mycoplasma, Coxiella, Chlamydia and Parvovirus B19 are negative.
The case is discussed with the Infectious Diseases Department who decide to admit the patient to perform different complementary tests in order to clarify the cause of this condition.
A gastroscopy was performed and suggested as a lymphoproliferative study of anemia. No findings of interest were found and a CT scan of the abdomen and pelvis showed lymphadenopathies in the upper mediastinum that after completing the study.
These lymph nodes are biopsied and the pathological study confirms that it is a Hodgkin lymphoma.
Currently the patient has started chemotherapy with good response to the initial clinic.
