발목 관절의 미만형 색소 융모 결절성 활액막염으로 오인된 통풍성 관절염: 증례 보고
Gouty Arthritis of the Ankle Misdiagnosed as Diffuse Pigmented Villonodular Synovitis: A Case Report
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Gouty arthritis involving extensive soft tissue deposition around the ankle joint can clinically and radiologically mimic pigmented vil lonodular synovitis (PVNS). This paper presents the case of a 35-year-old man initially suspected of having diffuse PVNS based on the clinical features such as swelling, pain, and restricted ankle motion, and the magnetic resonance imaging findings suggestive of soft tis sue masses and diffuse synovitis around multiple tendons. The patient underwent surgical intervention with a planned extensive syno vectomy, the gold standard treatment for diffuse PVNS. The intraoperative examination revealed the widespread deposition of gout to phi rather than hemosiderin-laden tissue, and histopathological analysis confirmed gouty arthritis. Diagnostic uncertainty arose because of mildly elevated serum uric acid levels, along with the absence of typical inflammatory signs such as redness or a heating sensation, and imaging characteristics overlapping with PVNS. This case shows that extensive gouty arthritis may closely mimic diffuse PVNS, highlighting the importance of including tophaceous gout in the differential diagnosis of patients presenting with joint effusion and dif fuse synovitis involving the joints and tendons, particularly in the presence of underlying metabolic syndrome risk factors
Abstract
Gouty arthritis involving extensive soft tissue deposition around the ankle joint can clinically and radiologically mimic pigmented vil lonodular synovitis (PVNS). This paper presents the case of a 35-year-old man initially suspected of having diffuse PVNS based on the clinical features such as swelling, pain, and restricted ankle motion, and the magnetic resonance imaging findings suggestive of soft tis sue masses and diffuse synovitis around multiple tendons. The patient underwent surgical intervention with a planned extensive syno vectomy, the gold standard treatment for diffuse PVNS. The intraoperative examination revealed the widespread deposition of gout to phi rather than hemosiderin-laden tissue, and histopathological analysis confirmed gouty arthritis. Diagnostic uncertainty arose because of mildly elevated serum uric acid levels, along with the absence of typical inflammatory signs such as redness or a heating sensation, and imaging characteristics overlapping with PVNS. This case shows that extensive gouty arthritis may closely mimic diffuse PVNS, highlighting the importance of including tophaceous gout in the differential diagnosis of patients presenting with joint effusion and dif fuse synovitis involving the joints and tendons, particularly in the presence of underlying metabolic syndrome risk factors