Chronic tophaceous gout with unusual large tophi: case report.

Nassira Aradoini,Fatima Zahra Abourazzak,Sofia Talbi,Taoufik Harzy,Khadija Berrada

doi:10.11604/pamj.2015.22.132.6447

Abstract

Gout is a metabolic disease, which is characterized by acute or chronic arthritis, and deposition of monosodium urate crystals in joint, bones, soft tissues, and kidneys. But large tophi are unusual in chronic gout. We report the case of a 67-year-oldArabman presenting chronic tophaceous gout with unusual large tophi involving multiple joints: hands, feet, elbows, and knees. Laboratory workup revealed elevated serum uric acid (96 mg/l, normal: 20-74 mg/l), with normal renal function test. In untreated patients, chronic tophaceous gout may develop, which is characterized by chronic destructive polyarticular involvement and tophi. The treatment consists to decrease serum uric acid level which eventually allows the regression of tophi.

Highlights

Gout is a metabolic disease that can manifest as acute or chronic arthritis, and deposition of monosodium urate crystals in joint, bones and different body tissues, including the skin and soft tissues
Chronic tophaceous gout frequently occurs after 10 years or more of recurrent polyarticular gout
Our case is a rare form of tophaceous gout, which presented with generalized tophi

Summary

Introduction

Gout is a metabolic disease that can manifest as acute or chronic arthritis, and deposition of monosodium urate crystals in joint, bones and different body tissues, including the skin and soft tissues. Our patient had only taken traditional medicines for joint pains and did not resort to specific therapy for gout He was noted to have multiple hard swelling. Physical examination revealed that there were multiple large firm tophi over bilateral hands, feet, elbows, and knees (Figure 1, Figure 2, Figure 3).Some of them are ulcerated and discharged white chalky material. He had an average built with BMI of 30,4 and hypertension fortuitously discovered. Laboratory workup revealed elevated serum uric acid (96 mg/l, normal: 20-74 mg/l), with normal renal function test: blood urea 0,4mg/l (normal: 0, 1- 0,5 mg/l) and serum creatinine 10mg/l (normal: 5-18 mg/l) Radiological examination of both hands showed soft-tissue swelling and periarticular erosions in interphalangeal joints (Figure 4). He was referred to urology care for his kidney stones

Discussion

Conclusion