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Secondary gout from myelofibrosis

Case contributed by Jayanth Keshavamurthy
Diagnosis certain

Presentation

Myelofibrosis. Right hand swelling, warmth and pain after receiving blood transfusion. 

Patient Data

Age: 75 years
Gender: Female

Name the arthritis?

x-ray

Findings:

  • There is diffuse soft tissue swelling.
  • There is no decreased mineralization of the juxta articular and periarticular carpal and metacarpal bones.
  • There are punched out erosive changes involving the base of the right first metacarpal with overhanging sclerotic edges.
  • No joint narrowing.
  • These findings are extremely concerning for gouty arthritis.

Case Discussion

Past medical history significant for myelofibrosis diagnosed 5 years ago (JAK2V17F positive). Taking Ruxolitinib 20mg BID , severe pulmonary hypertension, thrombocytosis, chronic anemia, history of TIA who presented with complaints of right hand swelling, warmth and pain after receiving blood transfusion. 

She was seen in the hematology clinic and was sent for a 2 unit blood transfusion.  The patient states that since this blood transfusion she has had pain, swelling, redness and warmth at the site on her right hand. Interestingly, the patient was documented by nursing to have received the transfusion in the left hand. 

Uric acid was checked and was more than twice normal at 12.8 mg/dl.

She was discharged home on colchicine 0.6 mg bid.

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