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Ulcerated tophaceous gout
  1. Michelle Gita Filanovsky1,
  2. Kumar Sukhdeo2,
  3. Megan Cunnane McNamara3
  1. 1Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  2. 2Case Western Reserve University, Cleveland, Ohio, USA
  3. 3Department of Internal Medicine, Louis Stokes Veterans Administration Medical Center, Cleveland, Ohio, USA
  1. Correspondence to Dr Kumar Sukhdeo, sukhdeo{at}


Gout is an inflammatory arthritis characterised by hyperuricemia, which, if poorly controlled, can lead to the development of tophi. We report the case of a 60-year-old Caucasian man with poorly controlled polyarticular tophaceous gout with multiple comorbidities (including renal failure) who presented with tophaceous ulcers of the upper extremity. These ulcers caused extreme pain, requiring chronic opiate medications, and were associated with decreased sensation and reduced ability to move the extremity. His hospital course was complicated by acute kidney injury, haemolytic anaemia and Clostridium difficile infection. He required 1 month of antibiotics and intensive wound care for his ulcers. This case highlights the diagnosis, natural history and management of an unusual complication of hyperuricemia.

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