Atypical Presentation of Gout: A Case Report
Ameen Abdel-Khalek1, Ammarah Tariq1, Joseph A White2
1Medicine, Saint James School of Medicine, Park Ridge, USA.
Cureus
|March 30, 2023
Summary
This case study highlights tophaceous gout presenting as leg nodules in a patient with normal uric acid levels. Treatment resolved inflammation and leukocytosis, demonstrating effective management of this uncommon gout manifestation.
Area of Science:
- Rheumatology
- Dermatology
- Pathology
Background:
- Gout, a common inflammatory arthritis, results from monosodium urate crystal deposition.
- It typically affects joints like the first metatarsophalangeal joint, causing pain and swelling.
- Tophaceous gout, a chronic manifestation, involves urate crystal deposits in soft tissues.
Observation:
- A 43-year-old male with obesity, hypertension, osteoarthritis, and gout presented with bilateral leg pain and mobility issues.
- Physical examination revealed bilateral tender nodular leg lesions.
- Laboratory tests showed persistent leukocytosis and elevated erythrocyte sedimentation rate (ESR), with normal uric acid levels.
Findings:
- Imaging studies including X-rays and ultrasound were unremarkable.
- Biopsy of the leg nodules confirmed tophaceous gout.
- Despite normal uric acid levels, the patient had symptomatic tophaceous gout.
Implications:
- This case underscores that tophaceous gout can manifest atypically, even with normal serum uric acid levels.
- Prompt diagnosis via biopsy and appropriate treatment are crucial for managing symptomatic tophaceous gout.
- Effective management can lead to resolution of inflammation and improvement in patient mobility.
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