Diagnosis Dilemma, Culture-Negative Periprosthetic Hip Infection Versus Acute Gouty Arthritis

Case: We report the case of acute gouty arthritis mimicking infection in a 59-year-old woman who had an extensive history of periprosthetic joint infection (PJI) and multiple revisions. Initial laboratory testing, examination, and recency bias suggested recurrent PJI, but aspiration revealed an acute gout attack without superimposed infection. The patient’s examination and serological markers improved off antibiotics, and she subsequently avoided an unnecessary revision surgery. Conclusion: Although rare, acute gouty arthritis should be considered in every patient, and complete workup should be performed, regardless of infectious or rheumatologic history.