{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T16:26:24Z","timestamp":1759422384123,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T00:00:00Z","timestamp":1541030400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2018,11,18]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>A 70-year-old woman with a background of portopulmonary hypertension, managed with sildenafil and oral diuretics, and cirrhosis, presented with acute on chronic haemorrhoidal bleeding, iron deficiency anaemia and worsening right heart failure. She presented in a normal conscious and cognitive state. Management involved intravenous diuresis with frusemide and blood transfusion. She quickly begun to develop fever, severe polyarticular arthropathy and progressive encephalopathy. Analgesia was started and antibiotics administered for potential septic sources. Extensive investigations, including full septic screen and neurological imaging, revealed no explainable aetiology for her precipitous decline. She continued to have febrile episodes, worsening polyarticular arthropathy and progressive encephalopathy eventually becoming unresponsive. Given the severe polyarticular arthropathy knee aspiration was performed. Urate crystals were identified and intravenous hydrocortisone and colchicine were started. Within 2\u2009days she achieved full resolution of her systemic, musculoskeletal and neurological symptoms. We propose this as a rare case of gout-induced encephalopathy.<\/jats:p>","DOI":"10.1136\/bcr-2018-227058","type":"journal-article","created":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T17:19:47Z","timestamp":1545153587000},"page":"e227058","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Polyarticular arthropathy and encephalopathy in a 70-year-old woman"],"prefix":"10.1136","volume":"11","author":[{"given":"Cameron Scott","family":"Lewis","sequence":"first","affiliation":[{"name":"Sir Charles Gairder Hospital, Perth, Western Australia, Australia"},{"name":"St John of God Subiaco, Perth, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohen","family":"Skiba","sequence":"additional","affiliation":[{"name":"St John of God Subiaco, Perth, Western Australia, Australia"},{"name":"Bendat Respiratory Research and Development Fund, Perth, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eli","family":"Gabbay","sequence":"additional","affiliation":[{"name":"Bendat Respiratory Research and Development Fund, Perth, Western Australia, Australia"},{"name":"University of Notre Dame, Perth, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,12,13]]},"reference":[{"key":"2025082801361486000_11.1.e227058.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1407298"},{"key":"2025082801361486000_11.1.e227058.2","first-page":"1341","article-title":"Recent diuretic use and the risk of recurrent gout attacks: the online case-crossover gout study","volume":"33","author":"Hunter","year":"2006","journal-title":"J Rheumatol"},{"key":"2025082801361486000_11.1.e227058.3","doi-asserted-by":"publisher","DOI":"10.1038\/nature04516"},{"key":"2025082801361486000_11.1.e227058.4","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/RHU.0b013e318293794f","article-title":"Acute polyarticular gout presenting as delirium","volume":"19","author":"Wilson","year":"2013","journal-title":"J Clin Rheumatol"},{"key":"2025082801361486000_11.1.e227058.5","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.eurger.2012.08.004","article-title":"A surprising cause of recurrent delirium; gout attack","volume":"3","author":"\u00d6zt\u00fcrk","year":"2012","journal-title":"Eur Geriatr Med"},{"key":"2025082801361486000_11.1.e227058.6","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/S0248-8663(97)80619-4","article-title":"L\u2019enc\u00e9phalopathie goutteuse: mythe ou r\u00e9alit\u00e9?","volume":"18","author":"Alla","year":"1997","journal-title":"La Revue de M\u00e9decine Interne"},{"key":"2025082801361486000_11.1.e227058.7","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.100727"},{"key":"2025082801361486000_11.1.e227058.8","doi-asserted-by":"crossref","unstructured":"Hall RJ , Watne LO , Cunningham E , et al . 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