Atypical presentation of gouty tophi in a resource-limited setting

A man in his early 50s from Tanzania presented with chronic nodular skin lesions and joint pain, likely due to gout complicated by obesity, after over 15 years of misdiagnosis and ineffective treatment. Despite various therapies for leprosy, tuberculosis and steroid use, his condition worsened, leading to hyperglycaemia and significant financial strain. Missed opportunities to use simple, low-cost diagnostic tests such as ultrasound and examining nodule fluid for urate crystals led to delays in diagnosis. Instead, unnecessary tests were performed, increasing costs without aiding diagnosis. This case highlights the need to use simple, available diagnostic tests in resource-limited settings before relying on costly investigations that can impose a heavy financial burden on patients. Likewise, it emphasises recognising atypical presentations of gouty tophi, such as isolated soft tissue involvement without joint involvement.