Abstract
A 76-year-old man had pain in the right hallux and a history of chronic tophaceous gout Radiographs of the right foot showed the typical findings of gouty arthritis in the first metatarsal phalangeal (MTP) joint consisting of well-defined punched-out erosions with overhanging edges. The first interphalangeal joint showed joint space narrowing, which is atypical for uncomplicated gout. Triple-phase bone scanning showed increased activity on all phases in both the first MTP and the first intraperitoneal joints, with activity greatest in the intraperitoneal joint Biopsy of the first toe at the intraperitoneal joint revealed crystalline material, consistent with gouty tophus. Culture of the bone was positive for Staphylococcus aureus, confirming the presence of septic arthritis. Although the triple-phase bone scan is highly sensitive and specific for infection, the presence of gout can be a pitfall in this diagnosis. In this case, activity was more intense in the first intraphalangeal joint, which was affected by septic and gouty arthritis, on all three phases of the bone scan than was the first MTP joint, which had only gouty arthritis.
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