Gout: A Case Report

Abstract

Gout is a common clinical condition, usually seen with typical manifestations of swelling, erythema, tophi, and heat at joint(s). However, in rare circumstances, gout can present atypically, and it is important to recognize and manage it with appropriate medical therapy. This case study dives into a particularly atypical presentation of tophaceous gout in a patient with numerous comorbidities that complicate management. Visually appreciating the tophi, in this case, allows one to get an idea of their distribution on the digits, their unique chalky-white appearance, and how the presentation changed after therapy was initiated. Additionally, learning about the in-depth management and step-wise escalation of treatment is a crucial takeaway from this case, especially in the backdrop of the patient’s CKD3b and CHF - making selecting pharmacotherapy a challenge. After some trial and co-consultation with nephrology, the final effective treatment course for this patient involved using a combination of Allopurinol and Pegloticase (Krystexxa) together; this provided both a clinical improvement and a decrease in lab values of uric acid, dropping from 11.4mg/dL at peak to 4.4mg/dL.