SUMMARY A 49-year-old man with long-standing gout suffered a spontaneous rupture of the Achilles tendon. Surgical repair was performed, and gouty tophi were found in the severed end of the tendon. The possible causes of this spontaneous rupture are discussed.Although an early treatise on gout describes 'violent stretching and tearing of ligaments" and a textbook attributes one of the causes of tendon rupture to gout,2 recent reports of tendon rupture in gout are rare.3 The purpose of this paper is to report a case of tendon rupture through gouty deposits. Case reportA 49-year-old policeman with a family history of long-standing gout in both grandfathers first developed mild attacks of gout himself at the age of 31 years. These attacks were initially infrequent and treated with colchicine and phenylbutazone. A random serum uric acid after 3 years was 10 3 mg/100 ml (618 ,tmol/l). Over the next few years attacks occurred about once a year but after 13 years the site and frequency increased involving the great toes, ankles, knees, and shoulders. He was started on allopurinol 100 mg t.d.s. by his general practitioner. Unfortunately this caused flushes and dizziness and was stopped.He was referred for a rheumatological opinion in 1974. Clinical examination revealed a large 18 stone (114 kg) man with a handlebar moustache, some discolouration of the right great toe, and limitation of movements of the right shoulder and both knees. There were no subcutaneous tophi. He was normotensive with no evidence of renal or cardiovascular disease. Haemoglobin 14 5 g/100 ml (14 5 g/dl), ESR 12 mm/hour, white blood count 5700 mm3 (5 7 x 109/1), serum uric acid 8-8 mg/100 ml (528 ,umol/l), blood urea 31 mg/100 ml (5-0 mmol/l).
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