Tophaceous gout in a renal allograft recipient.

Abstract

A 65-year-old female received a renal transplantation 3years ago, and her maintenance immunosuppressive regi-men included prednisolone 5 mg once daily (0.1 mg/kg/day), mycophenolate mofetil 1 g twice daily and cyclos-porin 125 mg twice daily (5 mg/kg/day) with averagetrough serum levels of cyclosporine between 200 and300 ng/mL since 3 months after renal transplantation.Her first episode of gouty arthritis developed more than10 years ago; however, the disease activity remained qui-escent, and there was no episode of gouty arthritis since 7years before renal transplantation. It was not until 2 yearsago, i.e. 1 year after transplantation, when the tophi firstappeared on the left hand during an episode of gouty ar-thritis, which was followed by frequent attacks since then.On admission, physical examination disclosed multiple to-phi on the left hand (Figure 1A) with exudation of white,chalky material from some tophi. Laboratory evaluationshowed a higher level of serum uric acid, up to 7.7 mg/dL,but the level of urinary uric acid excretion was lower, at175 mg/day (1 mmoL/day), and the creatinine clearancerate was 63 mL/min/1.73 m