Abstract
Gout is a metabolic disease characterised by acute or chronic arthritis and deposition of monosodium urate crystals around joint, bones, soft tissue and kidneys.
This is the case of a 51 year old man who re-presented with a nineteen year history of joint pains and five year history of multiple joint swellings. This followed his defaulting from follow up after an earlier presentation 16 years previously with acute gouty arthritis.
Clinical evaluation revealed a middle aged man with multiple swellings over the hands, ankles, feet, elbows and knees. Serum uric acid was very elevated and radiographs revealed large tophi involving multiple joints. Abdomino-pelvic ultrasound scan and renal function tests were normal.
He was subsequently treated with medications and had significant improvement with clear regression of the size of the tophi. This case demonstrates that delayed treatment of gout or neglected gout over time can lead to tophaceous gouty arthritis.