324 Reumatol Clin. 2006;2(6):324-6 Introduction Arthritis of the first metatarsophalangeal (MTP) joint of a different etiology than gout is known by the term pseudopodagra. Although the majority are due to deposits of other micro crystals, there has also been descriptions of other entities, such as infectious arthritis or lesion by foreign bodies. 1 We present the case of a patient with a septic pseudopodagra due to Streptococcus agalactiae with a refractory evolution. Clinical Case The patient is a 71-year-old male, with a history of pulmonary tuberculosis, chronic simple bronchitis, sygmoidectomy due to adenocarcinoma, and now free of neoplasm and chronic liver disease of unknown origin, probably due to the ingestion of alcohol. He came for the first time to the emergency department of our center in the month of August 2004, due to pain and swelling of the first MTP joint of the right foot, presenting during the past 24 hours fever. The physical exploration showed fever (37.5 o C), mucosal jaundice, stigmas of liver disease, a 3 cm liver enlargement, and mono arthritis of the first MTP of the right foot. On further examination, he showed a mild normocytic, normochromic anemia, 77 000/μL platelets, prothrombin time of 29% y and GOT 47 U/L, with the rest of the hemogram being normal, biochemistry, and urine sediment also normal. In spite of the patient not knowing that he had hyperuricemia and deniyng previous episodes of podagra, he was approached as gouty mono arthritis, and treatment with colchicine in a descendent pattern was established, as well as paracetamol and cryotherapy. A month later, the patient visited the outpatient rheumatology clinic with the persistence of pain and signs of inflammation, as well as fever in spite of the installed treatment. Due to the refractory podagra, a foot x-ray was taken, observing important bony erosions with joint destruction (see figure). With a diagnostic suspicion of septic mono arthritis in a patient with chronic liver disease in spite of systemic affectation, hospitalization was decided upon to his study. Physical exploration and revealed arthritis of the first MTP with signs of inflammation and the analysis showed: erythrocyte sedimentation rate of 8 mm/h; C reactive protein, 7.98 Correspondence: Dra. E. Riera. Sección de Reumatología. Hospital Universitari Germans Trias i Pujol. Carretera del Canyet, s/n. 08916 Badalona. Barcelona. España. E-mail: resireu@ns.hugtip.scs.es Manuscript received August 28, 2005; accepted for publication May 4, 2006. Pseudopodagra is an unusual cause of first metatarsophalangeal arthritis. There are multiple causes, and an infectious cause always has to be excluded. We report a septic pseudopodagra by Streptococcus agalactiae in a patient with chronic hepatopathy with an indolent evolution and a consequent delay in diagnosis. Antibiotic treatment was installed with a favourable outcome without functional sequelae. The pseudopodagra reports in the bibliography are reviewed with special attention on those of infectious aetiology. Key words: Pseudopodagra. Infectious arthritis. Streptococcus agalactiae. Seudopodagra séptica por Streptococcus agalactiae La seudopodagra es una causa infrecuente de artritis de primera metatarsofalángica (MTF). Entre sus múltiples causas, siempre hay que descartar el posible origen infeccioso. Se presenta un caso de seudopodagra séptica por Streptococcus agalactiae en un paciente con hepatopatía crónica en el que se retrasó el diagnóstico por su curso indolente. Recibió tratamiento antibiótico intravenoso con buena evolución y sin secuelas funcionales. Se realiza una revisión de los casos de seudopodagra descritos en la bibliografía, con especial atención en los de causa infecciosa. Palabras clave: Seudopodagra. Artritis infecciosa. Streptococcus agalactiae. Septic Pseudopodagra Caused by Streptococcus agalactiae Elena Riera, a Lourdes Mateo, a Meritxell Sallés, a and Ricard Pérez b a Sección de Reumatología. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. b Sección de Radiodiagnóstico. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. Clinical Cases