Olecranon bursitis as initial presentation of gout in asymptomatic normouricemic patients

Background Acute bursitis is a less frequent presentation of gout, especially in normouricemic subjects compared to the typical pattern of acute gouty arthritis. Aim of the work The aim of the current case reports is to describe the clinical and the magnetic resonance imaging features of acute gouty olecranon bursitis as initial presentation of acute gouty attack. Case report In this report we describe the clinical and MRI features of three cases presenting with acute gouty olecranon bursitis, in spite of normal serum uric acid and stable renal function. For all cases diagnostic aspiration was carried out to exclude septic bursitis as initial first step of management. The bursal fluid was also examined under Polarized microscopy and monosodium urate crystals were identified in the aspirated fluid with typical negative birefringence typical for urate crystals. The literature on MRI features of olecranon bursitis as atypical presentation of gout is reviewed. Conclusion Olcernaon gouty bursitis can be the initial presentation of acute gouty attack and should be considered in the differential diagnosis in acute presentation after exclusion of sepsis. The importance of bursal fluid analysis in such atypical presentation to look for monosodium urate crystals and excluding bacterial infection is quite important clinical task in such atypical presentation.