Tophaceous gout in a patient with thalassemia

We report a 46-year-old Greek female with thalassemia intermedia, who presented to our hospital with end stage renal disease of unknown etiology and tophaceous gout. In addition, skeletal manifestations characteristic of thalassemia were noted with massive extramedullary hematopoiesis presenting as posterior mediastinal masses. We report the first case in English literature of crystal proven gout in thalassemia intermedia and provide a review of the literature that indicates the relative rarity of gout in this clinical setting, despite evidence of urate overproduction in one report. The long survival and renal insufficiency may have contributed to our patients' tophaceous gout.