Chronic Tophaceous Gout with Unusual Large and Multiple Tophi at Various Joints with Acute Cellulitis like Presentation at Great Toe: Case Report

Dr Mazharuddin Ali Khan, Dr. Syed Yaser Quadri, Dr. Wasif Ishaqui

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 48-year-old resident of Kandukur region of Rangareddy district, Telangana, Hyderabad, presenting chronic tophaceous gout with unusual large tophi involving multiple joints: hands, feet, elbows, and knees and acute cellulitis/Abscess like presentation on left foot. Laboratory workup revealed normal serum uric acid (5.4 mg/dl, male it is 3.58.7mg/dL and in case of female it is 2.56.9mg/dL) 1 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.

Keywords: Gout, tophi, urate crystals, Cellulitis, Abscess, Great toe