https://orcid.org/0000-0002-4127-1101
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Weixian Lee, Anselm Mak, An atypically located solitary gouty tophus, Rheumatology, Volume 58, Issue 11, November 2019, Page 2075, https://doi.org/10.1093/rheumatology/kez124
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Extract
A 61-year-old man presented with a progressively enlarging left anterior shin tophus. Since age 20 years he had experienced recurrent monoarticular gout attacks that necessitated allopurinol use. He developed end-stage renal disease secondary to chronic glomerulonephritis at age 32 years and underwent kidney transplantation. Since then he has been on immunosuppressive therapy, including glucocorticoids, and his renal function has normalized. His gout attacks have not recurred despite persistently elevated (>8 mg/dl) serum uric acid, hence allopurinol was stopped, although the tophus continued to enlarge. Examination revealed a solitary, ulcerated mass of mixed firm and cystic consistency (Fig. 1A) that was histologically proven to be a gouty tophus. Tenting of the overlying skin resulted in a small superficial ulcer. On MRI, the 18 × 6 × 5 cm tophus resulted in scalloping of the tibia (Fig. 1B) and displacement of the anterior tibial artery and deep fibular nerve. The tophus was decompressed via ultrasound-guided aspiration. Allopurinol was re-instituted, targeting a serum uric acid level <5 mg/dl.
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