Tuberculous arthritis presenting as tophaceous gout

A 73-year-old black man with chronic gout presented with a 1 1/2 year history of a swollen painful left wrist. Two draining ulcers over the ventral aspect of his wrist and radiographic changes of the affected area suggested chronic gouty arthritis, but culture of the fluid from the wrist grew Mycobacterium tuberculosis. This case extends the list of infectious agents producing septic arthritis in patients with gout to include Mycobacterium tuberculosis. The need for culture evaluation of joint fluid in patients with chronic as well as acute gout is emphasized.