A Rare Case of Gout and Pseudogout in the Same Pedal Joint

Jenee Gooden, DPM:

My name is Jenee Gooden. I'm DPM and I am a first year podiatry resident practicing at Bridgeport Hospital, Yale New Haven Health.

Lady Paula DeJesus, DPM:

My name's Dr. DeJesus, DPM. I am the chief of podiatry at Greenwich Hospital, Yale New Haven Health. I am also a teaching attending at Bridgeport Hospital, Yale New Haven Health.

Kevin Vasquez-Monterroso, DPM:

Yes. My name is Kevin Vasquez-Monterroso. I am a first year at Bridgeport Hospital, Yale New Haven Health for podiatry.

Jenee Gooden, DPM:

So the thing that was unique to me was that a lot of times when you see gout, there's like this assumption that you see it and you just know that it's going to be gout, only gout. But when the path report came back that it was gout and also pseudo gout, it was just something rare because I know I've never seen it in the foot or many other joints in general. I think it was just something interesting to bring to light because a lot of times we can get complacent in what we see in our day to day and the norm of, oh yeah, this is just gout, which can skew our treatment plans.

Lady Paula DeJesus, DPM:

I think it's important to understand when to take the patient for a surgical debridement rather than just debriding in the wound care center or the office setting. Sometimes things are deeper. With this patient, the tendon was involved, and right under that tendon there is bone, which could lead to a bone infection, which could lead to an amputation. So it's important to understand when to take the patients who are surgical debridement and obtain correct pathology specimens to be sent out for proper diagnosis. So in this case, that is what we did. Also, just to remove all tophi, flush out well so that this wound can heal properly in a timely manner. So I think that's very, very important.

Kevin Vasquez-Monterroso, DPM:

So one of the things that I would want someone to take away from this case is the fact that I think we rely sometimes too much on anchor diagnoses just being as narrow as possible with a diagnosis. And then when a pathology report comes back as something we were maybe not expecting a hundred percent, it does happen. And I think being open to that possibility is always beneficial.

Jenee Gooden, DPM:

So another important thing about this case was multi-specialty like collaboration because this patient also is being seen by rheumatology. So just being able to collaborate with other specialties so that the patient can have the best care and the best outcome possible.