Atypical erosive tophaceous gout with severe osteolysis around multiple joints of the digits: A case report

Introduction: Gout is a chronic metabolic disorder secondary to hyperuricemia and is typically characterized initially by monoarticular arthritis starting at the distal extremities and may progress to tophaceous gout after several years of acute attacks of painful inflammatory arthropathy. Case presentation: We present a case of erosive polyarticular tophaceous gout with an atypical presentation of painless masses of both hands and severe osteolysis without periarticular osteopenia on radiographs. Laboratory examinations were requested, and the diagnosis was confirmed with a biopsy. She was started with pharmacologic therapy but due to the severity of the joint destruction and deformities, surgical debridement and arthrodesis was done for the distal interphalangeal joints of the right middle and ring finger, along with the metacarpophalangeal joint of the right thumb. Non-union and implant failure of the metacarpophalangeal arthrodesis occurred but there was noted improvement of her hand function. Conclusion: This case should be differentiated from multicentric reticular histiocytosis, rheumatoid arthritis, and psoriatic arthritis. Surgical treatment, such as joint fusion, may be effective in some cases of gouty nodules.