Presentation
The number of cells present in the corona and fibrovascular zones of the tophus was analyzed by Genmod mixed models analysis. RESULTS: Numerous CD68 mononucleated and multinucleated cells were present within the corona zone. [ncbi.nlm.nih.gov]
Examine these images and note the features that are present and also the features that would have been present if the tissue had been processed differently. 2. Discuss the etiology and pathogenesis of gout. 3. [medicine.tamu.edu]
While Morton’s neuroma is the most common cause of this presentation, this case illustrates that other pseudotumoral lesions, such as a gouty tophus, may present similarly, and should be considered in the differential diagnosis. [cureus.com]
Entire Body System
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Relapsing Polychondritis
Polychondritis (2) Sebaceous Cyst (6) Solid-Cystic Basal Cell Carcinoma (85) Synovioma (3) Xanthoma Tuberosum (1) related links Search www.google.com for 'Gouty Tophus' Informationen über Rheuma [dermis.net]
Respiratoric
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Rhinorrhea
The patient reported no epistaxis, rhinorrhea, nasal obstruction, traumatic episode, surgical history, or painful sensation. [journals.lww.com]
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Sputum
An extensive infectious workup to include blood, sputum, urine, synovial fluid, and cerebrospinal fluid cultures as well as hepatitis panel, human immunodeficiency virus, tuberculosis, and antigen testing for various bacterial, viral, and fungal etiologies [ncbi.nlm.nih.gov]
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Tachypnea
He presented with fevers, tachypnea, leukocytosis up to 35,400/μL, and C-reactive protein of 377 mg/L with no defined infectious source. He was treated with broad-spectrum antibiotics and itraconazole for antifungal coverage. [ncbi.nlm.nih.gov]
Musculoskeletal
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Joint Deformity
Complications include bone destruction, joint deformities, and, as in the present case, secondary infections. Diagnosis can be made on clinical grounds and confirmed with the visualization of uric acid crystals under light microscopy. [jaoa.org]
Overview Chronic symptoms such as joint deformity and limitation of motion in affected joints may occur if several attacks of gout occur each year. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues. [medlineplus.gov]
Your doctor should only suggest surgery if your case is extreme — for instance, your tophi have become infected, are causing major joint deformity or severe pain, or are compressing crucial nerves in your body (such as nerves in your spinal cord). [creakyjoints.org]
With longstanding tophaceous deposits, bone erosion occurs, and arthritis sets in which causes joint deformities. Acute attacks of gout cause intense pain, redness and swelling. [epmonthly.com]
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Tendon Disorder
(disorder) 447562003 MAPRULE IFA 402470003 Gouty tophus of digit (disorder) 447562003 MAPTARGET M10.08 6011000124106 MAPPRIORITY 2 447562003 MAPPRIORITY 4 447562003 MAPRULE IFA 281365008 Gouty tophus of prepatellar bursa (disorder) 447562003 MAPPRIORITY [bioportal.bioontology.org]
Skin
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Subcutaneous Nodule
Due to the articular findings and the presence of subcutaneous nodules, the diagnostic hypotheses included tophaceous gout and rheumatoid arthritis. Complementary exams and biopsy of a subcutaneous node were requested. [scielo.br]
In 1996, Iglesias et al. reported a case presented with a 6-year history of multiple subcutaneous nodules and no history of previous articular complaint. [16] They had reviewed literature and found out 28 similar cases that had subcutaneous nodules without [ijcasereportsandimages.com]
Here we report a 20-year-old male presenting with multiple subcutaneous nodules on bilateral feet and toes, left palm, right elbow, helix of left ear since last one and half year prior to any other manifestation of gout. [ijdvl.com]
Available from: To the Editor, A 68-year-old woman on long-term intermittent hemodialysis (HD) for end-stage renal disease (ESRD) secondary to hypertension presented with three subcutaneous nodules around the metatarsophalangeal joints of both hands [sjkdt.org]
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Cutaneous Manifestation
manifestations of an infectious process. [ncbi.nlm.nih.gov]
Clinical cutaneous manifestations of chronic gout are now rarely observed. However, the presence of degenerative tissues, as in idiopathic osteoarthritis of the fingers, may predispose to the deposition of urate crystals. [link.springer.com]
The cutaneous manifestations of gout are represented by intradermal lesions or subcutaneous nodules called tophi, commonly seen in avascular tissue over the ears, olecranon and prepatellar bursae or in acral sites, often associated with tendons. [cureus.com]
Face, Head & Neck
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Facial Mass
We suggest that US with FNAC should be considered as a tool for evaluating a facial mass before a definite treatment modality is chosen. [journals.lww.com]
Neurologic
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Cervical Cord Compression
Cervical cord compression due to intradiscal gouty tophus. Spine (Phila Pa 1976) 2012; 37 : E1534–E1536. 10. Kersley GD, Mandel L, Jeffrey MR. [nature.com]
Cervical cord compression due to intradiscal gouty tophus: brief report. Spine. 2012;37(24):E1534–6. CrossRef PubMed Google Scholar 19. Lui TH. Acute posterior tarsal tunnel syndrome caused by gouty tophus. [link.springer.com]
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Babinski Sign
Neurological examination showed decreased left lower limb strength and a positive Babinski sign. [ncbi.nlm.nih.gov]
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Clonus
Neurological examination showed that his lower limb strength had decreased (Grade 4/5) on the left and he had left ankle clonus. The lower abdominal and cremasteric reflexes were normal. [nature.com]
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Limb Weakness
Clinical manifestations of thoracic spinal gout range from back pain, unilateral or bilateral extremities paralysis, limbs weakness, sensory impaired to urinary retention. [nature.com]
Workup
We would like to highlight here the difficult diagnostic workup in a patient with history of cancer and the presence of a tophus inside the liver. [ncbi.nlm.nih.gov]
Laboratory workup revealed elevated serum uric acid (96 mg/l, normal: 20-74 mg/l), with normal renal function test. [panafrican-med-journal.com]
Treatment
Treatments with antibiotics and nonsteroidal antiinflammatory drugs were ineffective. However, prednisolone therapy was highly effective, and the patient's symptoms were rapidly ameliorated. [ncbi.nlm.nih.gov]
Clinical trials state that both pegloticase and febuxostat have been effective in the management of tophi, but treatment takes time. Occasionally, when medical treatment fails, surgical intervention becomes necessary to eliminate the tophi. [tandurust.com]
Prognosis
Prognosis The prognosis is good for patients who are diagnosed and treated early. Only when left untreated is FGD a disease with high morbidity (neurological sequelae) and mortality. [orpha.net]
Treatment and prognosis Treatment of gigantism can be challenging, as transsphenoidal surgery (which is considered first line therapy) often does not control growth hormone levels 1. [radiopaedia.org]
[…] surrounds fluffy (cotton candy-like) material), fibrotic synovium Site joints - classically large toe Associated Dx /-chronic renal failure, /-diabetes mellitus Clinical history usually male Symptoms joint pain Prevalence common Blood work urea elevated Prognosis [librepathology.org]
Etiology
Moreover, we address the possible etiologic role of chronic inflammation related to tophi and liver cancer. [ncbi.nlm.nih.gov]
To be familiar with the etiology, pathogenesis, histopathology, clinical presentation, and clinical course of tophaceous gout. OBJECTIVES 1. [medicine.tamu.edu]
Etiology: [2] Overproduction of uric acid 10% of cases. Reduced excretion of uric acid 90% of cases. May be genetic, e.g. URAT1 mutation. [3] [4] Renal failure. Treatments: [5] NSAIDs. Allopurinol. Colchicine - prophylatic. [librepathology.org]
Epidemiology
Epidemiology: [1] Male (Females relative risk 0.1). Renal failure. Diabetes mellitus. Etiology: [2] Overproduction of uric acid 10% of cases. Reduced excretion of uric acid 90% of cases. May be genetic, e.g. URAT1 mutation. [3] [4] Renal failure. [librepathology.org]
Epidemiology Gout affects approximately 5 million Americans and has historically been described as a disease that affects men; however, it also affects women. [dermaamin.com]
Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 2015;11:649–62. [2]. Forbess LJ, Fields TR. The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi. [journals.lww.com]
Crystal arthritides - gout and calcium pyrophosphate arthritis: part 1: epidemiology and pathophysiology. Z Gerontol Geriatr. 2017. DOI: 10.1007/s00391-017-1197-3. [Crossref], [Web of Science ], [Google Scholar] ]. [tandfonline.com]
Pathophysiology
Crystal arthritides - gout and calcium pyrophosphate arthritis: part 1: epidemiology and pathophysiology. Z Gerontol Geriatr. 2017. DOI: 10.1007/s00391-017-1197-3. [Crossref], [Web of Science ], [Google Scholar] ]. [tandfonline.com]
This process and the cell death associated with NETs (NETosis) likely evolved as a cellular strategy to counteract pathogens, but although scientists generally agree that it plays an important role in pathophysiology, they have found it difficult to quantify [the-rheumatologist.org]
[…] and neutrophils followed by chronic gouty arthritis with tophi in joints and urate nephropathy Causes 2 - 5% of chronic joint disease Sites 50% have initial attack in first metatarsophalangeal joint; also ankles, heels, knees, wrists, fingers, elbows Pathophysiology [pathologyoutlines.com]
Lesch-Nyhan syndrome, phosphoribosyl pyrophosphate synthetase overactivity, von Gierke disease) High-protein diet Obesity Combined decreased excretion and overproduction: : high alcohol consumption References:[3][1][4][5][6][7][8] Pathophysiology Clinical [amboss.com]
Prevention
The nasal bone defect was repaired with a titanium mesh plate to prevent nasal depression. He has fully recovered with no more nasal obstruction or recurrence of nasal tophus. [ncbi.nlm.nih.gov]
Large tophi should be removed to prevent any damage to your joint or loss of its range of motion. [healthline.com]