Deterioration in general condition secondary to polyarthritis in an elderly patient : a case report

Abstract

INTRODUCTION: Deterioration in general condition is a common presentation in elderly patients. However, it is often a sign of an underlying potentially reversable pathology. As a result, a thorough assessment is often required since it can prove detrimental if left untreated. The following case report gives a clear example of this.

CASE SUMMARY: An 83 year old lady was admitted to the acute hospital in view of speech disturbances and lower limb weakness. Her daughter noted an acute on chronic deterioration in general health over the previous weeks. She was found to be hypothermic. The underlying cause was not identified from initial investigations, so she was transferred to a rehab hospital once the hypothermia resolved. She then developed an asymmetrical migrating polyarthropathy involving medium and large joints of the right side of her body. She had a history of gout, so a trial of colchicine was given until blood results were available. She responded significantly and a diagnosis of pseudogout was made.

CONCLUSION: This is an unusual presentation of pseudogout which often manifests as a monoarticular arthritis. However, multimorbidity and polypharmacy associated with ageing, predispose to atypical presentations of common diseases. In turn, there may be delayed or misdiagnosis leading to inadequate treatment with consequent ‘deterioration in general condition’. As a result, a comprehensive geriatric assessment often involving a multidisciplinary team approach is the gold standard management in geriatric medicine.