人工膝関節置換術後急性期に痛風発作を生じた1例

Acute Gouty Arthropathy after Total Knee Arthroplasty. Case Report

　人工膝関節置換術(TKA)において術後感染は最も忌避される合併症の一つである．今回われわれはTKA術後に痛風発作を来し術後感染と鑑別を要した症例を経験したため報告する．症例は70歳の女性で，左TKA術後から発熱，炎症反応が持続した．感染を除外する目的で膝関節の穿刺を行った．関節液培養は陰性で，尿酸ナトリウム結晶が確認され痛風発作と診断した．非ステロイド性抗炎症薬とコルヒチンの内服を行い膝痛は軽快した．TKA後の発熱に対しては痛風発作の可能性も考慮すべきと考えられた．

　Infection is one of the most undesirable complications of total knee arthoroplasty (TKA).　We report a case of gouty arthropathy which should be considered in the differential diagnosis of a possible infection after TKA.　A 70-year old woman had prolonged fever and inflammatory reaction after TKA.　Twenty three days after surgery, joint fluid was aspirated to exclude septic arthritis.　Gouty arthritis was diagnosed based on monosodium urate crystals contained in the aspirated fluid and negative result of the culture.　Fever and inflammation resolved with non-steroidal anti-inflammatory drugs and colchicine.　Gouty should be considered as a differential diagnosis of the infection of TKA.