Disseminated Chronic Tophaceous Gout With Multi-Tissue Involvement

Gout is a metabolic condition in which hyperuricaemia leads to deposition of monosodium urate (MSU) crystals in synovial and peri-articular tissues. (1) Acutely, synovial deposition causes a painful inflammatory reaction. Over time, chronic hyperuricaemia can lead to deposition of uric acid crystals in alternate tissues, with granulomatous inflammatory responses forming gouty tophi. Chronic tophaceous gout affects approximately 3% of gout patients and presents as a spectrum from classical nodular tophi to rarer disseminated manifestations such as miliarial gout, panniculitis and ulcerative cutaneous gout. (2) This case details the management of a Maori patient in his 40s, presenting with acute infection of extruding gouty tophi across his lower limbs, managed with antibiotics, surgical debridement and oral urate-lowering therapy. Multiple secondary complications of gout were identified during his care, including involvement of tendons and nerves in gouty deposits (with rare involvement of forearm extensor tendons), early onset polyarticular osteoarthritis with joint destruction and osteopenia. This case demonstrates the widespread effects of this disease and a range of complications secondary to poorly controlled tophaceous gout.