title: Ulcerated tophaceous gout.
abstract: 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.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
authors.forename: Michelle Gita
authors.initials: MG
authors.lastname: Filanovsky
authors.affiliation: Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Kumar
authors.identifier: http://orcid.org/0000-0001-8725-6081
authors.initials: K
authors.lastname: Sukhdeo
authors.affiliation: Department of Internal Medicine, Louis Stokes Veterans Administration Medical Center, Cleveland, Ohio, USA.
authors.forename: Megan Cunnane
authors.initials: MC
authors.lastname: McNamara
mesh_terms: D000740:Anemia / Q000150:complications; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002137:Calculi / Q000150:complications*; D003015:Clostridium Infections / Q000150:complications / Q000188:drug therapy; D006073:Gout / Q000150:complications* / Q000473:pathology; D006722:Honey; D006801:Humans; D033461:Hyperuricemia / Q000150:complications* / Q000473:pathology; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000473:pathology*; D012883:Skin Ulcer / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D014456:Ulcer; D034941:Upper Extremity; D014527:Uric Acid / Q000378:metabolism*; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents; D014527:Uric Acid