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Disseminated Chronic Tophaceous Gout With Multi-Tissue Involvement
Yee Leng Loh1,2, Fiona Combe2,3
1Stroke and Rehabilitation Services Ipswich Hospital Ipswich Queensland Australia.
Clinical Case Reports
|August 9, 2026
Summary
This case study highlights severe gout complications in a Maori man, including infected tophi and joint destruction. Effective management involved antibiotics, surgery, and urate-lowering therapy for chronic tophaceous gout.
Area of Science:
- Rheumatology
- Metabolic Medicine
- Dermatology
Background:
- Gout is a metabolic disorder caused by hyperuricemia, leading to monosodium urate (MSU) crystal deposition.
- Chronic tophaceous gout, affecting ~3% of patients, involves granulomatous inflammation and tophi formation.
- Rare manifestations include miliarial gout, panniculitis, and ulcerative cutaneous gout.
Purpose of the Study:
- To detail the management of a complex case of infected, extruding gouty tophi in a Maori patient.
- To illustrate the diverse secondary complications associated with poorly controlled tophaceous gout.
Main Methods:
- Management included antibiotics for infection, surgical debridement of tophi, and oral urate-lowering therapy.
- Comprehensive assessment identified secondary complications affecting tendons, nerves, joints, and bone.
Main Results:
- Successful treatment of acute infection and tophi extrusion.
- Identification of rare tendon involvement (forearm extensor tendons) and significant polyarticular osteoarthritis with joint destruction and osteopenia.
Conclusions:
- Tophaceous gout can lead to widespread systemic complications, including rare musculoskeletal and cutaneous manifestations.
- Integrated management addressing infection, urate control, and secondary complications is crucial for patients with advanced gout.
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