Pre-patellar bursitis as a first presentation of gout

We describe the case of a patient who presented with an acute pre-patellar bursitis, which did not improve with antibiotics. Aspiration of the bursa when it became fluctuant revealed urate crystals. Diagnosis was a rare first manifestation of gout, the occurrence of which had not been reported previously in orthopaedic literature. We highlight the importance of aspiration in the management of bursitis and its importance when gout is suspected, especially in one in whom non-steroidal anti-inflammatory drugs (NSAIDs) has recently been stopped. It is important to appreciate that the presence of crystals does not exclude the presence of infection. Bursitis can be caused by gouty crystals, but an infective cause of bursitis can result in secondary gout. Uric acid levels are not useful for the management of the first presentation of gout. We propose a simple algorithm for the management of acute bursitis.