Acute Vestibular Syndrome as Manifestation of an Acute Attack Chronic Tophaceous Gouty Arthritis in Obese Man: A Case Report and Literature Review

Acute Vestibular Syndrome (AVS) is a clinical condition characterized by vertigo or dizziness that develops acutely (over seconds, minutes, or hours) is accompanied by nausea/vomiting, gait instability, nystagmus, and head-motion intolerance, and persists for a day or more. It was estimated affect 2 % of the population. Gouty arthritis is a metabolic disease on joint due to crystal uric acid deposition. AVS as the initial symptom of an acute attack of gouty arthritis is a rare case. Here, we are presenting a 38 years old man, obese came with sudden onset of vertigo with nausea, vomiting, tinnitus, sweating and also pain his great toe. Physical examination findings were normal, except for a head tilt, down beating rotatory nystagmus and also inflammation and tophy in metatarsal digiti I pedis dextra et sinistra. Blood test showed remarkable hyperuricemia. Patient was diagnosed with AVS and gouty arthritis and given intravenous fluid ringer lactate 20 drips per minute, betahistine mesylate 12 mg every 8 hours, flunarizine 5 mg every 12 hours, intravenous ranitidine 50 mg every 12 hours and intravenous ondansetron 8 mg every 12 hours and meloxicam 15 mg once a daily. The association between AVS and gouty arthritis remain unclear, but it is suggested through inflammation and oxidative stress which induced by monosodium urate level.