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. 2011 Aug 19:5:397.
doi: 10.1186/1752-1947-5-397.

Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report

Evangelos Falidas  1 , Efstathios Rallis, Vasiliki-Kalliopi Bournia, Stavros Mathioulakis, Emmanouil Pavlakis, Constantinos Villias
Affiliations

Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report

Evangelos Falidas et al. J Med Case Rep. .

Abstract

Introduction: Gout is a common inflammatory arthritis caused by articular precipitation of monosodium urate crystals. It usually affects the first metatarsophalangeal joint of the foot and less commonly other joints, such as wrists, elbows, knees and ankles.

Case presentation: We report the case of a 75-year-old Caucasian man with tophaceous multiarticular gout, soft-tissue involvement and ulcerated tophi on the first metatarsophalangeal joint of the left foot, on the first interphalangeal joint of the right foot and on the left thumb.

Conclusion: Ulcers due to tophaceous gout are currently uncommon considering the positive effect of pharmaceutical treatment in controlling hyperuricemia. Surgical treatment is seldom required for gout and is usually reserved for cases of recurrent attacks with deformities, severe pain, infection and joint destruction.

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Figures

Figure 1
Figure 1
Voluminous, erupted and ulcerated nodule on the first metatarsophalangeal joint of the left foot containing chalky material (on admission).
Figure 2
Figure 2
Voluminous tophi of the first and second metacarpophalangeal joint of the left hand. A small ulcerated tophus is also visible on the fingertip of the thumb.
Figure 3
Figure 3
Tophi of the interphalangeal joints of the right hand.
Figure 4
Figure 4
Sizable tophus of the right elbow.
Figure 5
Figure 5
Tophus of the medial surface of the right heel and small ulcer of the first interphalangeal joint of the right foot.
Figure 6
Figure 6
Radiographs of the foot. Total destruction of the first metatarsophalangeal joint and soft tissue swelling is shown as is focal involvement of dorsal and plantar surface of the foot (panniculitis).
Figure 7
Figure 7
Complete healing of the ulcer 40 days after the initial observation.
See this image and copyright information in PMC

References

    1. Brook RA, Forsythe A, Smeeding JE, Lawrence Edwards N. Chronic gout: epidemiology, disease progression, treatment and disease burden. Curr Med Res Opin. 2010;26:2813–2821. doi: 10.1185/03007995.2010.533647. - DOI - PubMed
    1. Neogi T. Clinical practice. Gout. N Engl J Med. 2011;364:443–452. doi: 10.1056/NEJMcp1001124. - DOI - PubMed
    1. Lee SJ, Terkeltaub RA, Kavanaugh A. Recent developments in diet and gout. Curr Opin Rheumatol. 2006;18:193–198. doi: 10.1097/01.bor.0000209434.82096.1f. - DOI - PubMed
    1. Sarma P, Das D, Deka P, Deka AC. Subconjunctival urate crystals: a case report. Cornea. 2010;29:830–832. - PubMed
    1. Iacobellis G. A rare and asymptomatic case of mitral valve tophus associated with severe gouty tophaceous arthritis. J Endocrinol Invest. 2004;27:965–966. - PubMed

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