Polyarticular symmetric tophaceous joint inflammation as the initial presentation of gout

A 76-year-old woman suffered from bilateral distal index finger pain and swelling. The patient had been initially treated with antibiotics for herpetic whitlow complicated by a secondary bacterial infection. Gout was diagnosed through clinical history, physical examination and identification of monosodium urate crystals in the joint aspirate. Gout appearing as polyarticular, symmetric tophi involving the periungual region and distal interphalangeal joint has not been previously described.