Male student L.M.H (male, 17 years old, in Hanoi) went to Medlatec General Hospital for examination due to pain in the first metatarsal joint of his left foot and was diagnosed with an acute attack of gout.
H's parents said that for the past 2 years, H often had a dull pain in the left big toe joint when moving, the pain went away after 3-5 days. Two days before being admitted to the hospital, the pain in H's left big toe joint increased, accompanied by swelling, heat, continuous pain, increased when moving, sometimes even at night. H had no history of trauma, no pain in other joints or spine, had not been treated, so she went to see a doctor.
Regarding personal and family history, parents said that H had Tetralogy of Fallot - the most common congenital heart disease with cyanosis, had surgery more than 15 years ago, so had regular cardiology check-ups, and was allergic to antibiotics (Ceftriaxone). H's maternal grandfather had gout.
MSc. Dr. Trinh Thi Nga - Head of the Department of Orthopedics, Medlatec Healthcare System - said: When examined, the patient's left big toe joint was hot and swollen, not red, painful when pressed next to the joint, limited active movement due to pain, no tophi were detected clinically. Before the preliminary diagnosis of gout monitoring, the patient was consulted for in-depth diagnosis of testing and imaging diagnosis.
Notable results included increased inflammatory blood test (BC: 14.42G/L, CRP: 13.47 mg/L), high blood uric acid: 543.22 µmol/L, and images of urate crystal deposits in the form of clusters at the first metatarsal joint of the left foot on dual-energy computed tomography (CT) scan. Therefore, the doctor diagnosed the patient with chronic gout.
Doctor Nga said: “Two years ago, H had similar symptoms as this time, but because he did not go for a check-up or examination, he did not know he had gout. That is, at the time of gout, H was only 15 years old. This time, when the patient was in a lot of pain, he went for a diagnosis and treatment.”
After 1 week of treatment, the family said that H's pain in the first metatarsal joint of his left foot was gone.
According to doctors, there are many causes of gout such as a diet high in protein and seafood, age and gender, drinking a lot of beer and alcohol for a long time, obesity, and having a family member with gout.
Once known as “rich people’s disease”, there are many cases of subjectivity. The case of student H is an example.
“H has a normal diet, is short (due to congenital heart disease), and is young, so when unusual signs appeared, the family subjectively thought it was caused by changes in the weather.
However, because H has congenital heart disease with cyanosis, he is at higher risk of gout and increased uric acid, and his maternal grandfather has gout as a genetic factor. Therefore, H needs to be examined and checked periodically every 3-6 months to best control gout," Dr. Nga noted.
