Chronic tophaceous gout arthritis with infected giant podagra on first ray: a case report

Author(s): Wayan Subawa, Putu Astawa, Nico Lie, Claudia Santosa & Richard Afandi*

Gout Arhritis is a purine metabolism disorder that leads to hyperuricemia and monosodium urate monohydrate crystal deposition in musculoskeletal system and others. Tophaceous deposits are well-known to lead joint destruction, which can be complicated by secondary infection condition. The prevalence and incidence of gout vary from a prevalence of < 1% to < 6.8% and an incidence of 0.58 per 1,000 person/years to 2.89 per 1,000 person/years.

We presented a case of 56-years-old male came with the complained of lumps on both ankles and feet since 9 y. From physical examination, we found multiple tophi on his feet and infected giant podagra on the right foot associated with secondary infection. This symptoms is enhanced by laboratory result and imaging that confirming chronic gout arthritis. For clinician, diagnosing gout arthritis sometimes quite challenging which requiring investigation through joint or tophi aspirations. There are some other diagnosis that often mimicking the clinical feature of gout arthritis like, cellulitis, Reiter's disease, Pseudogout and Rheumatoid Arthritis (RA).

Gout arthritis itself commonly treated with conservative treatment but 10% of patients with clinical gout developed destructive tophi. This kind of stage will need further surgical intervention, including; surgical reconstruction debridement and resection arthroplasty, joint fusion and even amputation.