Abstract
In November, 2004, a 65-year-old man presented to our interdisciplinary emergency department with an acute abdomen, arthritis in several large and small joints, and many white skin lesions, predominantly on his hands (figure, A). An exploratory laparotomy showed bacterial peritonitis due to perforation of the sigmoid colon of unknown aetiology. Hemicolectomy with iliostomy construction was done. White plaques all over the sigmoid and other parts of the colon were noticed intraoperatively. Fluid obtained from arthrocentesis of the right shoulder joint showed a tophaceous white mass and birefringent crystals on compensated polarisation microscopy.
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