An unusual case of multiple subcutaneous large tophi

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A 76-year-old man with a 30-year history of gout was admitted for chronic renal failure and the articular pain at the right foot. He was noted to have multiple hard swelling. The swelling developed over 10 years, progressively increasing in size. Physical examination revealed that there were multiple large firm tophi on the hands, both olecranon processes, and feet (Figure 1A). Figure 1. ( A ) Multiple large subcutaneous tophi are seen in the feet. ( B ) 3D CT images of the right foot demonstrating extensive tophi (dorsal view). Laboratory investigations showed: serum uric acid 728.0 μmol/l (155.0–428.0 μmol/l), urea 10.3 mmol/l (2.8–8.2 mmol/l) and creatinine 213.3 μmol/l (35.0–104.0 μmol/l). Three-dimensional computed tomography (3D CT) …