Series Editor: Herbert L. Fred, MD

Prepared by Mary B. White, MD, Assistant Professor of Medicine, UCLA School of Medicine, Department of Ambulatory Care, West Los Angeles VA Medical Center, Los Angeles, Calif

An Inflamed, Swollen Olecranon Bursa
A 59-year-old man presented with a painful elbow of 4 days’ duration. Physical examination revealed a tender, red, tense, and fluctuant right olec­ranon bursa (Figure). Range of motion in the right elbow was normal. The patient drank large amounts of beer and would lean on his elbow while reading.

Pertinent laboratory findings included: total leukocyte count, 8000/µL; serum creatinine, 1 mg/ dL; uric acid, 7.7 mg/dL; synovial fluid leukocyte count, 20,000/µL, with 90% neutrophils. Polarized light microscopy revealed numerous negatively birefringent crystals. Gram’s stain and culture of the fluid were negative.

Acute gout was diagnosed, and the patient was prescribed high doses of indomethacin (Indocin). Within 2 days his symptoms had greatly improved.

Points to remember: Gout should always be considered in the differential diagnosis of an acutely inflamed joint or bursa. Initial presentation usually involves the first metatarsophalangeal joint, but almost any joint or bursa can be affected. Predisposing factors include male gender, increasing age, obesity, local trauma, alcohol abuse, renal insufficiency, consumption of purine-rich foods, and the use of thiazide diuretics.

Diagnosis: Acute gouty olecranon bursitis.