Asymptomatic Gouty Tophi in Thyroid Cartilage: A Case Report and Literature Review.

Gouty tophi is a disease characterized by the long-term deposition of monosodium urate crystals in joints or cartilages. The most commonly affected site is the first metatarsophalangeal joint, and gouty tophi in the head and neck region are relatively rare. This article reports a case involving an elderly male with asymptomatic gouty tophi in the thyroid cartilage. The patient had a history of gout for over 10 years and presented with a painless thyroid mass that had been present for at least 3 years. He had not received systemic treatment. Preoperative contrast-enhanced cervical CT results indicated a high likelihood of gouty tophi. Postoperative pathology confirmed the mass to be consistent with gouty nodules. Following the procedure, the patient was treated symptomatically with non-busulfan tablets and colchicine. No recurrence was observed at the 1-year follow-up. This report highlights the need to consider gouty tophi in cases of prolonged gout history and abnormal imaging findings in the head and neck region. Appropriate management, including urate-lowering therapy and surgery, if necessary, can lead to optimal outcomes and prevent recurrences. Further research is warranted to enhance understanding and clinical management of this uncommon regional manifestation of gout.

Dual-Energy Computed Tomography (DECT) Resolves the Diagnostic Dilemma in an Atypically Presenting Case of Gout.

Gout is a common inflammatory arthropathy that presents as acute monoarthritis, most commonly of the first metatarsophalangeal (MTP) joint. Chronic polyarticular involvement may lead to confusion with other inflammatory arthropathies, including rheumatoid arthritis (RA). A thorough history, physical examination, synovial fluid analysis, and imaging are keys to establishing a correct diagnosis. Although a synovial fluid analysis remains the gold standard, the affected joints may be difficult to access by arthrocentesis. In cases where a large monosodium urate (MSU) crystal deposition is in the soft tissues - the ligaments, bursae, and tendons, it becomes a clinical impossibility. In such cases, dual-energy computed tomography (DECT) can assist in differentiating gout from other inflammatory arthropathies, including RA. Additionally, DECT can perform quantitative analysis of tophaceous deposits and, therefore, assess response to treatment.

Sepsis complicated with secondary hemophagocytic syndrome induced by giant gouty tophi rupture: A case report.

BACKGROUND: Gouty tophi are a chronic granulomatous caused by a deposition of monosodium urate crystal deposition in the body. Once broken, it may easily induce severe infection. Sepsis complicated with secondary hemophagocytic syndrome induced by gouty tophi rupture is extremely rare in the clinical setting, and no such serious complications have been reported in literature. CASE SUMMARY: This is a 52-year-old Chinese male patient with a 20-year history of gouty arthritis. At admission, the gout stone in the patient's right ankle was broken and it secreted a white mucoid substance. During the course of treatment, the patient suffered from systemic inflammatory response syndrome multiple times. His condition gradually deteriorated, further complicated by hemophagocytic syndrome. After thorough removal of gout lesions and active anti-infection treatment and control of blood uric acid level, combined with multidisciplinary cooperation, the patient was finally cured. CONCLUSION: Sepsis complicated with secondary hemophagocytic syndrome induced by gouty tophi rupture is extremely rare in the clinical setting. Timely and accurate diagnosis is very important to save patients' lives.

Outcomes of surgery for gouty tophi in the extremities.

<b> Introduction:</b> Gouty tophi occur in approx. 50-60% of patients suffering from gout. Their occurrence is related to severity of disease and effectiveness of treatment. They develop more frequently in patients with long lasting and poorly controlled disease.</br></br> <b>Aim:</b> The aim of the study was to evaluate the results of surgical treatment of gouty tophi of the upper and lower extremities. </br></br> <b>Materials and methods:</b> The results of surgical treatment of gouty tophi in the extremities in 14 patients, 13 men and 1 woman, at a mean age of 51 years, are presented. Twelve patients had tophi localized in the upper extremities, whereas 3 had tophi in the lower limbs (1 patient had upper and lower extremity involved). The duration of disease to the operation was a mean of 8 years. </br></br><b> Results:</b> Seven patients received excision of a single tophus, and the remaining patients had 3-15 operations performed due to multiple tophi over a period from 3 months to 2 years. The treatment outcomes were assessed at a mean of 3 years (range 2-8) after the last operation in a form of phone interview. </br></br> <b>Conclusions:</b> All patients declared satisfaction from the result of treatment. No case of complication or tumor recurrence was noted. The results confirm usefulness of surgical treatment in this form of gout.

Tofo gotoso gigante en presentación inusual / Giant gouty tophi in unusual presentation

La gota es una enfermedad reumática inflamatoria que se debe al depósito de cristales de urato monosódico en las articulaciones. En su evolución clínica se distingues dos formas: la fase aguda caracterizada por un proceso inflamatorio monoarticular agudo de gran sensibilidad, y la fase crónica o de mantenimiento, cuyo elemento fundamental es la acumulación de cristales de urato monosódico llamados tofos gotosos. Estos se presentan con mayor frecuencia en el dorso de los dedos, a nivel articular y en el pabellón auricular. Se presenta el caso de un paciente masculino, de 47 años, con diagnóstico de gota de 5 años de evolución y con tratamiento irregular. Este paciente presentó tofos gotosos en localizaciones infrecuentes que limitaron su capacidad funcional. Este caso demuestra la necesidad de un diagnóstico oportuno y una adecuada adherencia al tratamiento, por lo que se considera importante para la comunidad médica, especialmente los profesionales de la salud que atienden a pacientes con artropatía gotosa(AU)´

Gout is a rheumatic, inflammatory disease that is generated by the deposition of monosodium urate crystals at the joint level. Two forms can be distinguished in its clinical evolution: the acute phase characterized by an acute monoarticular inflammatory process of great sensitivity, and the chronic or maintenance phase where the fundamental element is the presence of accumulations of monosodium urate crystals called gouty tophi. These occur more frequently on the back of the fingers, at the joint level and in the auricle. This paper presents the case of a 47-year-old male patient, diagnosed with gout for 5 years and with irregular treatment, who presented gouty tophi in infrequent locations that limit the patient's functional capacity. The case is presented considering it important for the medical community; especially health professionals caring for patients with gouty arthropathy(AU)´

Multiple gouty tophi in the head and neck with normal serum uric acid: A case report and review of literatures.

BACKGROUND: Gouty tophus is rarely reported in the head and neck areas. To the best of our knowledge, this is the first report on multiple gouty tophi in the head and neck with normal serum uric acid (SUA) levels. CASE SUMMARY: We report a case of multiple gouty tophi in the nasal dorsal and auricle regions with normal SUA levels. The patient was admitted to the hospital with a chief complaint of recurrent nasal swelling and pain for 3 years, which was aggravated for 3 d. The patient's SUA level had been regularly reviewed in the outpatient department and had been successfully controlled for several years. Resection of the nasal masses was performed. Cartilage from the right ear cavity was used to repair the nasal defects. The pathological report confirmed a nasal gouty tophus. No recurrence or deformity was found after a 1 year follow-up. CONCLUSION: Normal SUA cannot completely negate the diagnosis of gouty tophus, especially in some rare regions.

A Rare Case of Destruction of the First Metatarsophalangeal Joint in a Patient With Gout.

Gout is a crystal deposition disorder caused due to the deposition of monosodium urate crystals in joints and other tissues secondary to hyperuricemia. Podagra is the term for gout of the first metatarsophalangeal joint. In our case report, a 30-year-old male patient came to our OPD with complaints of swelling over the first metatarsophalangeal joint for one year, which was insidious in onset, localized, and had a sudden increase in size over the past three months. The patient also complained of an inability to properly wear his shoe. A plain radiograph was done, which was suggestive of an expansile lesion with the destruction of the first metatarsophalangeal joint and the erosion of the joint surface extending to the head of the first metatarsal and the proximal phalanx of the great toe. Lab investigations revealed a serum uric acid level of 10.2 mg/dl and an acid phosphatase level of 8.92 U/L. Excision of the lesion was done and a frozen section biopsy was sent intra-operatively which confirmed the presence of monosodium urate crystals. A fibular strut graft was taken to fill the defect using a square nail passing through the first metatarsophalangeal joint and a Kirschner wire was added to the interphalangeal joint to maintain the stability of the reduction. The foot was immobilized for six weeks following which the Kirschner wire was removed and range-of-motion exercises started. There was no residual deformity, and the patient responded well to the treatment.

Deformidad articular secundaria a artropatía gotosa / Joint deformity secondary to gouty arthropathy

RESUMEN La artropatía gotosa es una enfermedad inflamatoria que afecta fundamentalmente a pacientes masculinos por encima de los 50 años de edad. Su principal expresión clínica desde el punto de vista articular es la presencia de un cuadro inflamatorio monoarticular de elevada sensibilidad. Cuando el diagnóstico es tardío, el tratamiento inadecuado o no existe adherencia terapéutica por parte de los pacientes, los cristales de urato monosódico se acumulan en forma de tofos gotosos que no solo afectan la función articulares, sino que generan gran discapacidad y afectación de la percepción de la calidad de vida relacionada con la salud. Se presenta la imagen poco frecuente de gran acumulación de tofos gotosos en el dorso de ambas manos que limita considerablemente la movilidad articular, la capacidad funcional y la percepción de la calidad de vida secundaria a una no adherencia farmacológica del paciente.

ABSTRACT Gouty arthropathy is an inflammatory disease that mainly affects male patients over 50 years of age. Its main clinical expression from the joint point of view is the presence of a highly sensitive monoarticular inflammatory picture. When the diagnosis is late, the treatment is inadequate or there is no therapeutic adherence by the patients, the monosodium urate crystals accumulate in the form of gouty tophi that not only affect joint function, but also cause great disability and impairment of perception quality of life related to health. The rare image of a large accumulation of gouty tophi on the back of both hands is presented, which considerably limits joint mobility, functional capacity, and the perception of quality of life secondary to the patient's pharmacological non-adherence.

Intra-osseous tophaceous gout of a bipartite patella mimicking aggressive bone tumour.

This is a very rare case of gouty tophus in the patella of a 31-year-old male, without any medical co-morbidities. The patient initially presented after an injury to left knee but came back months later due to persistence of pain. Surgical decision was made based on imaging findings in computed tomography and magnetic resonance imaging of an intraosseous lesion that has increased in size. The initial diagnosis is that of an aggressive bone tumour. The diagnosis of an intraosseous gout was made intra-operatively upon seeing the characteristics of the lesion, and upon confirmation of the biopsy results. Gout can usually be managed medically with urate lowering drugs and lifestyle change. However, when presented with a tophus that is increasing in size and causing mass effect on the involved bone, surgical management is indicated.

Volumetric reduction and dissolution prediction of monosodium urate crystal during urate-lowering therapy - a study using dual-energy computed tomography.

METHODS: Baseline and follow-up DECTs were performed under a standard ULT protocol. Monthly dissolution rates were calculated by simple and compound methods. Correlations with average SU were compared and analyzed. Best-fit regression model was identified. MSU dissolution times were plotted against SU at different endpoints. RESULTS: In 29 tophaceous gout patients, MSU volume reduced from baseline 10.94 ± 10.59 cm3 to 2.87 ± 5.27 cm3 on follow-up (p = .00). Dissolution rate had a stronger correlation with SU if calculated by compound method (Pearson's correlation coefficient r= -0.77, p = .00) and was independent of baseline MSU load. The ensuing dissolution model was logarithmic and explained real-life scenarios. When SU > 0.43 mmol/l, dissolution time approached infinity. It improved to 10-19 months at SU = 0.24 mmol/l. When SU approximated zero (as with pegloticase), dissolution flattened and still took 4-8 months. CONCLUSION: MSU dissolution is better described as a logarithmic function of SU, which explains, predicts, and facilitates understanding of the dissolution process.

Unusual Case of Gouty Arthritis of the Second Distal Interphalangeal Joint (Second Toe).

Gout is one of the most common diseases affecting men globally due to the spread of unhealthy dietary habits, kidney disease, and the use of diuretics. It is characterized as having monosodium crystals depositions in the synovial fluid, which causes an inflammatory response and painful joints. Most of the time, it can be found affecting the first metatarsophalangeal joint or other large joints in concurrence with other disorders. Non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and steroids have been known to suppress such events in most cases without the need for any surgical intervention. We present a case of a 44-years-old medically free healthy male who presented with a case of gouty arthritis in the second distal interphalangeal joint. Initially, colchicine treatment was given along with NSAIDs, but symptoms failed to subside. After a persistent increase of swelling and pain, the surgical evacuation was sought to reduce the pain and exclude any other causes of arthritis. Histopathology report confirmed the presence of monosodium urate crystals without any signs of infection. In conclusion, surgical intervention of gouty arthritis can be beneficial in cases of persistent pain and increasing rate of swelling despite the medicinal trial, especially in unusual cases of gouty arthritis such as gout of the second metatarsophalangeal joint.

Rapid disappearance of gouty tophi of the foot by resection of massive gouty tophi of the opposite foot in a patient with hyperuricaemia: a case report.

Gouty tophi occur less frequently and disappear only with modern medication therapy for symptomatic or asymptomatic hyperuricaemia. However, the medication may require a long time to take effect due to the systemic urate pool associated with massive gouty tophi. We present the case of a 37-year-old woman who suffered from massive gouty tophi of both feet due to hyperuricaemia. After resection of the massive gouty tophi from her right foot and treatment with uricemia medication, the gouty tophi of her opposite foot disappeared rapidly due to reducing the patient's systemic urate pool with intensification of drug medication.

Vertebrae Destruction with Cauda Equina Syndrome Secondary to Spinal Gouty Arthritis: A Case Report.

Gouty arthritis commonly affects peripheral joints and is associated with hyperuricaemia. Spinal manifestations of gouty arthritis are not common, and majority of published articles worldwide were case reports. This is a case report of spinal gouty arthritis that presented with spinal vertebrae destruction and cauda equina syndrome. The magnetic resonance imaging (MRI) showed destruction of L5/S1end plates with cystic collection mimicking infective changes. The tissue histological examination confirmed presence of urate crystal needles that displayed negative double refraction on light microscopy. Spinal gouty arthritis is part of the differential diagnoses in gouty arthritis patients.

Unusual presentation of gouty tophus in the liver with subsequent appearance in the same site of HCC: a correlate diagnosis? Case report.

BACKGROUND: Although gout is a common disease, the presence of gouty tophi outside joints is rare and in literature, there is to date only one report of hepatic tophaceous nodule. We would like to highlight here the difficult diagnostic workup in a patient with history of cancer and the presence of a tophus inside the liver. Moreover, we address the possible etiologic role of chronic inflammation related to tophi and liver cancer. CASE PRESENTATION: We present the case of a 72-year-old man with a localization of gouty tophus in the liver, who thereafter developed a hepatocellular carcinoma (HCC) in the same site. The patient was followed up after surgery for left renal cancer from 1992 to 2011, when a hepatic nodule was discovered for the first time. After a detailed evaluation, the nodule was classified as a urate tophus of the liver. However, further follow-up showed that the nodule increased in size and changed its characteristics, bringing to the diagnosis of HCC. CONCLUSIONS: With the present case report, we would discuss the possible neoplastic degeneration of a gouty tophus and its etiologic role favouring cellular degeneration linked to chronic inflammation. We would also highlight the importance of histopathological evaluation of hepatic lesions in gouty patients at high risk of liver neoplasm, due to the difficulty in characterizing gouty tophi by imaging.

Chronic Tophaceous Gout Presenting as Bilateral Knee Masses in an Adult Patient: A Case Report.

INTRODUCTION: Gout is a common disorder of uric acid metabolism that leads to the precipitation of monosodium urate crystals. It most commonly affects the first metatarsophalangeal joint but can also affect other joints such as knees, elbows, wrists, and ankles. Chronic gout can present as recurrent episodes of monoarticular or polyarticular inflammatory arthritis, tophaceous soft tissue deposits of monosodium urate crystals, uric acid renal calculi, and/or chronic nephropathy. CASE REPORT: We report the case of a 67-year-old Caucasian male patient with bilateral tophaceous gout to his knees involving the soft tissue and ulcerating skin breakdown to his left knee after an acute traumatic injury. Plain radiographs of the bilateral knees revealed large soft tissue masses anterior to the patella. Magnetic resonance imaging of the left knee was also performed which demonstrated heterogeneous masses consistent with tophi and peripheral enhancement with central necrosis. A diagnostic biopsy was performed to rule out malignancy the results confirmed gouty tophi. We report this case to note the atypical presentation of this disease. CONCLUSION: Chronic tophaceous gout presenting with ulcerating skin breakdown overlying a fungating tophaceous mass is uncommon considering the current availability of effective pharmaceutical treatments for hyperuricemia. Surgical intervention for tophaceous gout is seldom required and is traditionally reserved for atypical cases that present with deformities, severe pain, and joint destruction. Although ulcerative tophi are rare, they can have significant morbidity and greatly impact patients' quality of life. Surgical intervention was indicated in our patient to excise the mass and avoid infective complications.

Multiple Gouty Tophi with Bone Erosion and Destruction: A Report of an Early-onset Case in an Obese Patient.

A 27 year-old severely obese man (BMI, 35.1) had hyperuricemia and multiple gouty tophi with bone erosion and destruction, resulting in gait disturbance for 6 years after the early onset of gout at 21 years of age. His hyperuricemia was associated with hyperinsulinemia in obesity and a genetic variant of the ABCG2 gene. In addition, multiple gouty tophi with bone erosion and destruction might have been caused by hypoadiponectinemia and the elevation of the patient' s pro-inflammatory cytokine (IL-1ß) level with the accumulation of visceral fat. In this case, bone and Ga-67 scintigraphy were useful for detecting the location and magnitude of gouty tophi.

Fibrosarcoma arising from gouty tophi: report of a unique case and review of literature.

Fibrosarcoma is a malignant mesenchymal tumor. To the author's best knowledge, no previous case of fibrosarcoma arising from gouty tophi has been reported. Here we reported the first case of fibrosarcoma arising from gouty tophi. A case of 58-year-old man was presented with a mass with ulcer and infection in the second joint of left middle finger for 2 months, with long standing gouty tophi. The tumor was biopsied and the biopsy showed complete excision of the tumor. With the pathological and immunohistochemical features considered, the diagnosis of fibrosarcoma associated with gouty tophi was made. The clinical findings, pathological characteristics and treatment were described.

Curettage as an Effective Treatment for Gouty Tophi on the Ear / 대한피부과학회지

No abstract available.