Vegetarian diet induced new onset acute gouty arthritis in a middle-aged genetically predisposed male: A rare presentation

Gout is a metabolic disease characterised by acute or chronic arthritis which is due to deposition of Monosodium urate (MSU) crystals in joints and soft tissues. Classically described as a disease associated with hyperuricemia which may be due to metabolic defect in uric acid production or due to impaired renal excretion.We present a case of 45 year old nondiabetic, non-alcoholic, non-smoker male presented to orthopaedic OPD with complain of pain in right hand and left leg with restriction of joint mobility for past 14 hours.On carefully eliciting the dietary history patient revealed that he was a vegetarian and was on high purine rich diet for past 2 weeks due to family functions and various gatherings. Patient gave the history of consumption of cauliflower, mushrooms, beans along with sweetened carbonated drinks on two consecutive days before the onset of these symptoms.Serum uric acid 4.5 mg/dl, C-reactive protein was 9 mg/dl. To best of our knowledge this is the first case being reported in literatures where purine rich vegetarian diet has induced new case of gout.This kind of gout precipitation after consuming vegetarian diet is rarely reported in literature. This case report emphasizes upon the need of special caution to be taken by persons who are genetically predisposed to gout, while consuming purine rich diet like red meat, seafood, cauliflowers, spinach, rajma, Bengal gram, mushrooms, soft drinks sweetened with fructose.