Chronic multiarticular tophaceous gout with abnormally large tophi, case of surgical intervention: a case report from Nepal

Gout is an inflammatory disease caused by the deposition of monosodium urate monohydrate crystals around the synovial joints, affecting the first metatarsophalangeal joints followed by ankle and knees. It is found to be more prevalent among men and older women. Tophi tends to develop if the acute phase of the disease is not controlled. In contrast, our patient had an unusual presentation of multiple tophi affecting several joints accompanied by deformities. Here, the authors present a case of a 63 years old male with chronic multiarticular tophaceous gout with a history of more than 30 years. He presented with multiple joint deformities and prior surgical history of excision of tophi. Laboratory reports revealed elevated serum uric acid, and X-ray showed joint deformities with tophi. However, the parameters of renal function test were normal. Surgical excision of the tophi was done. Gout is one of the most common inflammatory arthritis, which if untreated can progress to tophi formation. The diagnosis can be made clinically and by several investigations including serum uric acid estimation and aspiration of the joint to reveal monosodium urate monohydrate crystals. A long standing case of multiarticular tophi causing joint deformities does require surgical intervention. Early treatment and diagnosis of hyperuricemia prevent the progression to gouty arthritis and tophi formation. Long history of multiple tophaceous gout is an unusual presentation, which we intend to present here as a novel case report. Nevertheless, such cases require surgical interventions.