Sir.—In their report Yarom et al1 comment on the association of secondary gout in childhood with inborn errors of purine metabolism, glycogen storage disease type I, familial syndromes of hyperuricemia and renal disease, severe uremia, and myeloproliferative disorders (leukemia and lymphoma), but they make no mention of secondary juvenile metabolic gout caused by well-compensated intracorpuscular hemolysis.2 Although Vora3 has eloquently described juvenile gout associated with well-compensated hemolysis without anemia due to deficiency of isozymes of phosphofructokinase, and though we have emphasized the importance of measuring red blood cell phosphofructokinase and its isozymes in children with unexplained gout,4 we find no mention of this subject or these studies by Yarom et al.1 We also find no mention of reticulocyte count or red blood cell survival time. We note the hemoglobin value of 16.9 mg/dL in their 14-year-old female patient (case 2) and wonder whether her
JACOBS JC. Juvenile Metabolic Gout. Am J Dis Child. 1985;139(9):860–861. doi:10.1001/archpedi.1985.02140110014011
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