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Gout can mimic aggressive bone lesions, presenting diagnostic challenges for clinicians and radiologists. This case highlights tophaceous gout mimicking malignancy in a renal transplant patient.

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Area of Science:

  • Rheumatology
  • Radiology
  • Pathology

Background:

  • Gout is a common metabolic disorder characterized by hyperuricemia and urate crystal deposition.
  • Imaging features of gout can be misleading, often mimicking other pathologies like bone tumors or infections.
  • Renal transplant patients may have altered presentations of gout due to immunosuppression and comorbidities.

Observation:

  • A 52-year-old male renal transplant recipient presented with a slow-growing left shin mass.
  • Initial radiography revealed a calcified lesion, initially presumed benign.
  • Fine needle aspiration confirmed gout deposition, with no change for eight years.

Findings:

  • The lesion rapidly enlarged, exhibiting aggressive imaging features including calcification disruption and MRI enhancement.
  • Histological examination of the surgically excised mass confirmed tophaceous gout.
  • This presentation mimicked a malignant bone lesion, underscoring gout's mimicry.

Implications:

  • Tophaceous gout can present as an aggressive bone lesion, posing a diagnostic dilemma.
  • Awareness of gout's diverse imaging spectrum is crucial for accurate diagnosis and management.
  • This case emphasizes the importance of considering gout in the differential diagnosis of bone lesions, even with atypical features.