title: "Unusual Cause Of Tophi With Renal Thrombotic Microangiopathy".
abstract: Chronic neutrophilic leukemia (CNL) is a rare entity amongst myeloproliferative neoplasms (MPNs). The classical presentation of CNL is with splenomegaly, mature neutrophilic leucocytosis and hyperuricemia. We herein report a case who presented with symptoms of acute gouty arthritis. Physical examination showed typical red, tender tophi in the right hand, right foot and both pinnae suggesting an acute episode of gout. During evaluation, moderate splenomegaly, mature neutrophilia, hyperuricemia and sub-nephrotic range range proteinuria were noted. Bone marrow examination and kidney biopsy was done. Final diagnosis of CNL with acute gouty arthritis and chronic renal thrombotic microangiopathy (TMA) was made. Although hyperuricemia is a common finding in MPNs but presentation of our case with symptoms of acute tophi and chronic TMA is atypical.
authors.affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Kamal Kant
authors.initials: KK
authors.lastname: Sahu
authors.affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Arjun Datt
authors.initials: AD
authors.lastname: Law
authors.affiliation: Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Varun
authors.initials: V
authors.lastname: Dhir
authors.affiliation: Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Shano
authors.initials: S
authors.lastname: Naseem
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Ritambhra
authors.initials: R
authors.lastname: Nada
authors.affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Subhash Chander
authors.initials: SC
authors.lastname: Varma
authors.affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Malhotra