Abstract

To the Editor:

A 77-year-old male with a history of hypertension presented with progressively worsening bilateral leg weakness and difficulty walking, along with right knee pain and severe back pain for a week. Outpatient medications included hydrochlorothiazide. He had occasional alcohol intake. Physical examination was significant for effusion in the right knee along with marked hyporeflexia and decreased power in both lower extremities. Laboratory values were remarkable for an erythrocyte sedimentation rate of 160 mm/h, serum uric acid of 10.7 and leukocytosis of 14,000/ mm³. Magnetic resonance imaging of the spine showed erosive bone changes around the facet joints of the L5 and S1 vertebrae. CT-guided aspiration recovered small amounts of fluid positive for monosodium urate crystals, and with negative Gram staining and culture growth. Synovial fluid analysis from both knees revealed the same findings. He was placed on prednisone and colchicine. His ambulatory status improved quite remarkably over the next 2 days. Upon discharge, he was able to walk out of the hospital and was placed on allopurinol. There were no recurrences.