Cutaneous Dissemination of Tophi Indicating Poorly Managed Gout: A Case Report

Gout is a systemic metabolic disease caused by chronic hyperuricemia.Poor adherence to urate-lowering therapy is a major contributor to chronic gout.Disseminated cutaneous tophi are rare manifestations of tophaceous gout.We report the case of a 72-year-old man with chronic gout, presenting with multiple disseminated tophi, destructive polyarthritis and renal failure.A 72-year-old man was hospitalized due to severe disabling pain in both ankles and heels, leading to an inability to walk.His BMI was 30 kg/m².Joint examination revealed ankle arthritis and mild flexion contractures affecting the hands, elbows and knees.Cutaneous manifestations included surgical scars on the fingers; large, firm, painless subcutaneous swellings on the second left finger, left elbow and along the postero-external aspect of the left forearm; diffuse infiltrated yellowish nodules, some ulcerated, on the legs, the left auricle and the third left finger.Biological tests showed metabolic syndrome with uncontrolled diabetes, mixed dyslipidemia and an elevated serum uric acid level of 530 µmol/L.He also presented with severe renal insufficiency and an elevated CRP level of 100 mg/L.Cutaneous biopsies from different sites revealed monosodium urate crystals, confirming the diagnosis of diffuse cutaneous tophi.Conventional radiographs of the hands and feet showed signs of gouty arthropathy.The patient was treated with colchicine (0.5 mg/day), prednisolone (30 mg/day for 3 days), atorvastatin, ramipril and insulin glargine (8 IU in the evening), resulting in favorable clinical improvement.