Joint pain is a common complaint in pediatrics and is most often attributed to overuse or injury. In the face of persistent, severe, or recurrent symptoms, the differential typically expands to include bony or structural causes versus rheumatologic conditions. Rarely, a child has two distinct causes for
joint pain. In this case, an obese 15-year-old male was diagnosed with
gout, a disease common in adults but virtually ignored in the field of pediatrics. The presence of
juvenile idiopathic arthritis (JIA) complicated and delayed the consideration of this second diagnosis. Indeed, the absence of
gout from this patient's differential diagnosis resulted in a greater than two-year delay in receiving treatment. The patients' BMI was 47.4, and he was also mis-diagnosed with
osteochondritis dissecans and underwent medical treatment for JIA, assorted imaging studies, and multiple
surgical procedures before the key history of increased
pain with red meat ingestion, noticed by the patient, and a subsequent elevated
uric acid confirmed his ultimate diagnosis. With the increased prevalence of
obesity in the adolescent population, the diagnosis of
gout should be an important consideration in the differential diagnosis for an arthritic joint in an
overweight patient, regardless of age.