Tophaceous Gout with Multiple Unusual Large Tophi and Severe Joints Destruction–A Pictorial Case Report

Gout is a chronic metabolic disease that can manifest as acute or chronic arthritis, and deposition of monosodium urate crystals in joint, bones, soft tissues and kidneys. It can either manifest as acute arthritis or chronic tophaceous gout. It usually affects the first metatarsophalangeal joint of the foot and less commonly other joints such as wrists, elbows, knees and ankles. We report a case of a 17 year old young boy with tophaceous multiarticular gout with unusual large tophi in hands, feet and knees. Severe joint destruction and ulcers due to tophaceous gout are currently uncommon considering the positive effect of medical treatment in controlling hyperuricemia. In this case we emphasize the disabling effects of undertreated hyperuremic arthropathy.