Rheumatoid arthritis (RA) and gout are common diseases, but their coexistence is rare. We describe the case of a 76-year-old man with hypertension who had been treated for gout for 20 years on allopurinol and colchici...Rheumatoid arthritis (RA) and gout are common diseases, but their coexistence is rare. We describe the case of a 76-year-old man with hypertension who had been treated for gout for 20 years on allopurinol and colchicine. He was seen in consultation for deforming polyarthritis of the small and large joints, which had been evolving for about 2 years. The acute episode occurred 10 days earlier with the onset of bilateral and symmetrical polyarthritis affecting the large and small joints. The physical examination revealed a peripheral joint syndrome with ulnar gale force deformities of the hands and several buttonhole deformities of the fingers. In addition, there were nodules, some of which were fistulised, giving rise to a chalky slurry. The biology revealed an inflammatory syndrome in addition to rheumatoid factors and ACPA, which were elevated. Biological analysis of the nodular fluid revealed clusters of sodium urate crystals and ultrasound scans of the joints revealed a double-contour appearance in several joints. The diagnosis of RA was made using the 2010 ACR/EULAR criteria. The patient was treated as an outpatient with corticosteroids before being put on methotrexate. It is important to understand that these two conditions can occur at the same time, so it is important to consider them when treating patients with gout or RA.展开更多
Summary: Many anomalies can be observed in the basilar trunk, such as aneurysms. Basilar trunk aneurysms are rare with a low reported prevalence. In this study, we describe a case of ischaemic stroke revealed by a bas...Summary: Many anomalies can be observed in the basilar trunk, such as aneurysms. Basilar trunk aneurysms are rare with a low reported prevalence. In this study, we describe a case of ischaemic stroke revealed by a basilar trunk aneurysm associated with venous thromboembolic disease. The patient was 60 years old and had no specific pathological history. She was seen for a sudden onset of right hemiplegia associated with dysarthria that had been present for 12 hours. The physical examination revealed a pyramidal syndrome and an altered general condition. An emergency cerebral computed tomography (CT) scan showed evidence of a cerebrovascular accident associated with a saccular aneurysm. We adopted the diagnosis of a deep left sylvian stroke associated with a superficial right sylvian stroke in the setting of an incidentally discovered basilar trunk aneurysm. On the 9<sup>ème</sup> day of hospitalisation, the patient experienced sudden onset of respiratory distress in conjunction with a warm, painful swelling of the right leg. TTE revealed signs of pulmonary embolism, with thrombi in the inferior vena cava and right atrium. Pulmonary embolism was highly probable, with a modified Geneva score of 15. We adopted the diagnosis of DVA complicated by pulmonary embolism in the setting of a basilar trunk aneurysm. The patient was transferred to the cardiology department, where she received oxygen therapy and thrombolysis with streptokinase. The immediate outcome 6 hours later was the sudden death of the patient due to the onset of cardiogenic shock.展开更多
文摘Rheumatoid arthritis (RA) and gout are common diseases, but their coexistence is rare. We describe the case of a 76-year-old man with hypertension who had been treated for gout for 20 years on allopurinol and colchicine. He was seen in consultation for deforming polyarthritis of the small and large joints, which had been evolving for about 2 years. The acute episode occurred 10 days earlier with the onset of bilateral and symmetrical polyarthritis affecting the large and small joints. The physical examination revealed a peripheral joint syndrome with ulnar gale force deformities of the hands and several buttonhole deformities of the fingers. In addition, there were nodules, some of which were fistulised, giving rise to a chalky slurry. The biology revealed an inflammatory syndrome in addition to rheumatoid factors and ACPA, which were elevated. Biological analysis of the nodular fluid revealed clusters of sodium urate crystals and ultrasound scans of the joints revealed a double-contour appearance in several joints. The diagnosis of RA was made using the 2010 ACR/EULAR criteria. The patient was treated as an outpatient with corticosteroids before being put on methotrexate. It is important to understand that these two conditions can occur at the same time, so it is important to consider them when treating patients with gout or RA.
文摘Summary: Many anomalies can be observed in the basilar trunk, such as aneurysms. Basilar trunk aneurysms are rare with a low reported prevalence. In this study, we describe a case of ischaemic stroke revealed by a basilar trunk aneurysm associated with venous thromboembolic disease. The patient was 60 years old and had no specific pathological history. She was seen for a sudden onset of right hemiplegia associated with dysarthria that had been present for 12 hours. The physical examination revealed a pyramidal syndrome and an altered general condition. An emergency cerebral computed tomography (CT) scan showed evidence of a cerebrovascular accident associated with a saccular aneurysm. We adopted the diagnosis of a deep left sylvian stroke associated with a superficial right sylvian stroke in the setting of an incidentally discovered basilar trunk aneurysm. On the 9<sup>ème</sup> day of hospitalisation, the patient experienced sudden onset of respiratory distress in conjunction with a warm, painful swelling of the right leg. TTE revealed signs of pulmonary embolism, with thrombi in the inferior vena cava and right atrium. Pulmonary embolism was highly probable, with a modified Geneva score of 15. We adopted the diagnosis of DVA complicated by pulmonary embolism in the setting of a basilar trunk aneurysm. The patient was transferred to the cardiology department, where she received oxygen therapy and thrombolysis with streptokinase. The immediate outcome 6 hours later was the sudden death of the patient due to the onset of cardiogenic shock.
