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Area of Science:

  • Rheumatology and Dermatology
  • Metabolic disorders
  • Crystal-induced arthritis

Background:

  • Gout is a metabolic disorder caused by monosodium urate crystal deposition.
  • Tophi, or crystal accumulation in connective tissue, typically manifest in the chronic stage, usually after 10 years of disease onset.
  • Tophaceous gout as an initial presentation is considered uncommon.

Purpose of the Study:

  • To report three cases of tophaceous gout presenting as the initial symptom.
  • To highlight the importance of dermatological awareness for early diagnosis and management.
  • To underscore the need for investigating underlying causes of hyperuricemia.

Main Methods:

  • Case series reporting three patients with painful subcutaneous nodules and hyperuricemia.
  • Clinical evaluation, laboratory investigations (including uric acid levels), and histopathology.
  • Diagnostic confirmation of gout with tophi as the primary manifestation.

Main Results:

  • Three patients (aged 70, 33, and 53) presented with painful subcutaneous nodules due to tophaceous gout.
  • All patients exhibited hyperuricemia, necessitating investigation into uric acid metabolism.
  • Diagnosis was confirmed via laboratory and pathology findings, with tophi being the initial sign.

Conclusions:

  • Tophaceous gout can uncommonly present as the first clinical manifestation of the disease.
  • Dermatologists must be aware of this rare presentation for timely diagnosis and intervention.
  • Early management, including patient education, lifestyle changes, and medication, led to favorable outcomes and symptom alleviation.