Probable Acromioclavicular Joint Gout in Two Patients With Longstanding Gout: A Report of Two Cases

Acromioclavicular (AC) joint gout is uncommon and can be difficult to distinguish from infection or degenerative disease without synovial crystal confirmation. We describe two older men with longstanding, intermittently treated gout who presented with symptomatic AC-joint abnormalities. A 74-year-old man had four months of bilateral AC-joint swelling, peripheral tophi, hyperuricemia, erosive radiographic changes, and supportive ultrasonographic findings, including a double-contour sign at the knee. A 94-year-old man had three months of right AC-joint pain and swelling, hyperuricemia, radiographic irregularity, and ultrasonographic synovial changes with power Doppler activity. Neither patient had an accessible AC-joint effusion for aspiration; therefore, crystal identification and bacterial culture were unavailable. The findings were compatible with probable AC-joint gout, but infection could not be definitively excluded, especially in the second patient, whose C-reactive protein was 74 mg/L. Colchicine and long-term urate-lowering therapy were prescribed; treatment details and standardized longitudinal outcomes were incompletely documented. These cases emphasize cautious diagnostic interpretation of unusual-site gout without tissue confirmation.