WINNIPEG, MAN. — The clinicians wondered whether this patient had
rheumatic nodules, gout, or some other disease process.
The rheumatologist suggested that blood tests, x-rays, an MRI, and a number of other tests would be needed to determine the cause of the finger nodules. These suggested procedures would require a return visit from the patient several weeks later.
“I was watching this and wondering whether there was an easier way” to make the diagnosis, Dr. Benjamin K. Fisher said at the annual conference of the Canadian Dermatology Association.
After the clinicians finished discussing the case, with the agreement of his colleagues and the patient, Dr. Fisher incised one of the nodules and pressed against it with the side of the scalpel. Out came yellow toothpaste-like matter that he smeared on a slide and placed under a microscope.
“I'd never done it that way before, and I didn't know if I'd see anything,” said Dr. Fisher, professor of dermatology at the University of Tel Aviv and the University of Toronto.
And then, “Lo and behold, there were all these [uric acid] crystals, and obviously this patient had gout,” he said.
This very simple procedure sped up the diagnosis by at least 3 weeks and saved the patient the time, cost, and hassle of undergoing further testing.
“This is a procedure that any one of you can do in your office,” Dr. Fisher pointed out.
A pasty exudate gained by incising one of the hand nodules showed crystals.
Polarized light microscopy showed crystals that were consistent with gout. Photos courtesy Dr. Benjamin K. Fisher