Tophi as first manifestation of gout

Abstract

Chronic tophaceous gout classically occurs after 10 years or more of recurrent polyarticular gout. However, tophi can also occur as first sign of the disorder. Here we report a 20-year-old male presenting with multiple subcutaneous nodules on bilateral feet and toes, left palm, right elbow, helix of left ear since last one and half year prior to any other manifestation of gout. He was having mild intermittent arthritis since last six months. Fine Needle Aspiration Cytology of one tophus showed monosodium urate crystals, which are pathognomonic for gout. His serum uric acid was normal and ultrasound revealed bilateral nephrocalcinosis. So far as we know, this is the first case report from India, demonstrating tophi as the initial clinical presentation of gout.

Cytodiagnosis of Gouty Tophi With Review of Literature

“…[2], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21 ], [22], [23] Details of these are shown in ( …”

“…Bothale et al [13] 2012 1 Great toe Rheumatoid arthritis Koley et al [14] 2010 1 Bilateral feet and toes, left palm, right elbow, helix of left ear Arthritis Gupta et al [15] 2009 1 Left elbow joint and near the lateral malleolus of the left foot…”

New Onset of Very Large Tophi in a Patient After Kidney Transplantation

“…1 Although gouty tophi are seen in chronic disease, in a few conditions tophi may be the first sign of the disorder. 2,3 Hyperuricemia is a common complication in organ transplant recipients and frequently is associated with chronic cyclosporine immunosuppressive therapy. 4,5 Kidney transplant recipients are prone to develop post-transplant hyperuricemia.…”

Tophi gout around the knee joint: An unusual presentation with a soft tissue mass

“…Photomicrograph of another section had been stained by de Galantha's method for demonstration of monosodium urate crystals ( Figure 2). subcutaneous nodules, knee, acromioclavicular joint and axial skeleton [3][4][5][6][7][8][9][10][11][12][13][14]. A recent study suggested that the frequency of axial involvement may be as high as 14% in patients with clinical or crystal-proven gout [15].…”

“…Chronic tophaceous gout classically occurs after 10 years or more of recurrent polyarticular gout. However, demonstrating tophi as the initial clinical presentation of gout is very rare [8]. Subcutaneous tophi generally occurs as a late clinical outcome and typically located in the peripheral joints of the hand or foot [10].…”