A case of gouty arthritis following percutaneous radiofrequency ablation for hepatocellular carcinoma.
Percutaneous radiofrequency thermal ablation (RFA) is considered an effective technique for providing local control in the majority of Hepatocellular carcinoma (HCC) patients. Although RFA is generally well tolerated, recent studies have reported complications associated with RFA. We describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal insufficiency. Regular surveillance of the patient detected a 3.5 cm HCC lesion. Because the patient had declined surgery, RFA was chosen for therapy. On the third post-procedural day, the laboratory results showed increases in his uric acid and potassium levels, which were compatible with a tumor lysis syndrome. On the 6th post-procedural day, the patient complained of new right knee pain. Subsequent joint aspiration revealed monosodium urate monohydrate crystals. We made the diagnosis of acute gouty arthritis arising from tumor lysis and liver infarction caused by HCC ablation, which was aggravated by acute renal insufficiency. After adequate hydration and administration of oral colchicines, the patient's right knee pain subsided and the uric acid serum level returned to normal. This is the first described case of acute gouty arthritis after RFA for a HCC lesion in a patient with underlying chronic renal insufficiency. To avoid hyperuricemia and an acute attack of gout after RFA therapy for HCC, early identification of patients at risk is warranted, such as those with a large tumor, rapid tumor growth, and renal insufficiency, and preventative measures should be considered.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yungun-dong, Chongno-gu, Seoul 110-744, South Korea.
Dae Hee
DH
Choi
Hyo-Suk
HS
Lee
D000368:Aged; D015210:Arthritis, Gouty / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D003078:Colchicine / Q000627:therapeutic use; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome
D006074:Gout Suppressants; D003078:Colchicine