A 33-yr-old male ran 10 miles, drank some beer, and developed
pain in his left knee and ankle. He took some leftover
antibiotics but was no better after 6 d, when a
heart murmur and an aortic valve nodule were discovered. He was presumed to have
endocarditis with
septic arthritis and was started on intravenous
antibiotics. On the second hospital day, synovial fluid analysis revealed acute
gout, and the patient improved very rapidly on anti-
gout therapy. The valvular nodule remained unexplained, but one very rare cause of valvular heart nodules is visceral
gout. An unsuccessful attempt to resorb the nodule was made by using
allopurinol. This patient demonstrates several points about
gout in endurance athletes: 1) acute
gout can mimic infectious
endocarditis, 2) misdiagnosed or undertreated
gout often leads to multiple joint involvement and sometimes to visceral tophi, and 3) athletes who exercise in warm weather and quench their thirst with cold beer are at risk for acute
gout.