GOTA TOFÁCEA CRÓNICA: PRESENTACIÓN DE UN CASO

Angel Inostroza; José Manuel Ríos Yuil

Submitted October 18, 2024

Published 2026-04-06

Artículos de Investigación

Vol. 18 No. 2 (2005): Revista Médico Científica

CHRONIC TOPHACEUS GOUT: A CASE REPORT

Angel Inostroza⁺⁻
José Manuel Ríos Yuil⁺⁻

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Published: 2026-04-06

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Abstract

We are presenting the case of a 42 years old male patient with the diagnosis of gouty arthritis (13 years of evolution) and chronic kidney failure (nine years of evolution) who was admitted to internal medicine service on September 15, 2005, due to five very inflammatory ulcers over a tophus on his left foot (10 days of evolution). He presented a deforming arthritis with fingers ankylosis and many tophi on his hands, elbows, knees and feet. X-rays revealed punch injuries of the bones and soft tissue calcification. Polarized light microscope revealed multiple birefringent needle shaped crystals in a whitish secretion in one of the ulcers. Creatinine, blood urea nitrogen, uric acid and potassium levels were always high. At the beginning, he had leukocytosis with neutrophilia.

Gout is the result of a purine metabolism disorder, which is characterized by hyperuricemia with uric acid deposits in joints and soft tissue.

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References

Miku LS, Farrar JT, Bilker WB, Fernandes S, Schumacher HR, Saag KG. Gout epidemiology: results from the UK General Practice Research Database, 1990-1999. Ann. Rheum. Dis, Feb 2005; 64:267-72.
Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 2004; 350:1093-1103, Mar 11, 2004.
Jones A, Perkins P. Gout. Ann. Rheum. Dis, Oct 1999; 58:611-17.
Myers A. NMS Medicina Interna. Cuarta Edición. México 2003. 697-703.
Cotran R, Kumar V, Collins T. Robbins Patología Estructural y Funcional. Sexta edición. México 2000. 1299-1302.
Jaramillo M, Godbout M, Naccache P, Oliver M. Signaling events involved in macrophage chemokine expression in response to monosodium urate crystals. J. Biol. Chem., Diciembre 10, 2004; 279(50):52797-52805.
Bourgoin SG, Desaulniers P, Fernandes M, Gilbert C, Naccache PH. Crystal-induced neutrophil activation. VII. Involvement of Syk in the responses to monosodium urate crystals. J. Leukoc. Biol., Octubre 1, 2001; 70(4):659-68.
Di Giovine FS, Duff GW, Malawista SE, Nuki G. Interleukin 1 (IL-1) as a mediator of crystal arthritis: stimulation of T-cell and synovial fibroblast mitogenesis by urate crystal-induced IL-1. J Inmunol 138:3213, 1987.
Braunwald E, Fauci A, Kasper D, Hauser S, Jameson J, Longo D. Harrison Principios de Medicina Interna. Décimoquinta edición. México 2003. p. 2332-34.
Emmerson BT. Drug therapy: the management of gout. N Engl J Med 1996; 334:445-51.
Terkeltaub R. Gout. N Engl J Med 2003; 349:1647-1655, Oct 23, 2003.
Dessein P, Joffe B, Ramokgadi J, Shipton E, Stanwix A. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann. Rheum. Dis, Jul 2000; 59:539-43.
Burgos-Vargas R, Meoño Morales E, Pacheco-Tena C, Vázquez-Mellado J. Relation between adverse events associated with allopurinol and renal function in patients with gout. Ann. Rheum. Dis, Oct 2001; 60:981-83.
Lin KC, Lin HY, Chou P. The interaction between uric acid level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study. J Rheumatol 2000; 27:1501-5.
Caspi O, Lubart E, Graff E. The effect of mini-dose aspirin on renal function and uric acid handling in elderly patients. Arthritis Rheum 2000; 43:103-8.
Rich MW. Uric acid: Is it a risk factor for cardiovascular disease? Am J Cardiol 2000; 85:1018-21.
Niskanen LK, Laaksonen DE, Nyyssonen K. Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study. Arch Intern Med 2004; 164:1546-51.
Wannamethee SG, Shaper AG, Whincup PH. Serum urate and the risk of major coronary heart disease events. Heart 1997; 78:147-53.
Emmerson B. Hyperlipidaemia in hyperuricaemia and gout. Ann Rheum Dis 1998; 57:509-10.
Fruehwald-Schultes B, Peters A, Kern W, Beyer J, Pfutzner A. Serum leptin is associated with serum uric acid concentrations in humans. Metabolism 1999; 48:677-80.
Pascual E, Balllè-Gualda E, Martinez A. Synovial fluid analysis for diagnosis of intercritical gout. Ann Intern Med 1999; 131:756-9.
Popp JD, Bidgood WO, Edwards NL. Magnetic resonance imaging of tophaceous gout in the hands and wrists. Semin Arthritis Rheum 1996; 25:282-9.
Morris I, Varughese G, Mattingly P. Colchicine in acute gout. BMJ 2003; 327:1275-6.
Clive DM. Renal transplant-associated hyperuricaemia and gout. J Am Soc Nephrol 2000; 11:974-9.
Shoji A, Yamanaka H, Kamatani N. A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum 2004; 51:321-5.
Riedel AA, Nelson M, Joseph-Ridge N, et al. Compliance with allopurinol therapy among managed care enrollees with gout: a retrospective analysis of administrative claims. J Rheumatol 2004; 31:1575-81.
Takahashi S, Moriwaki Y, Yamamoto T, Tsutsumi Z, Ka T, Fukuchi M. Effects of combination treatment using anti-hyperuricemic agents with fenofibrate and/or losartan on uric acid metabolism. Ann Rheum Dis 2003; 62:572-5.

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[1] Miku LS, Farrar JT, Bilker WB, Fernandes S, Schumacher HR, Saag KG. Gout epidemiology: results from the UK General Practice Research Database, 1990-1999. Ann. Rheum. Dis, Feb 2005; 64:267-72.

[2] Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 2004; 350:1093-1103, Mar 11, 2004.

[3] Jones A, Perkins P. Gout. Ann. Rheum. Dis, Oct 1999; 58:611-17.

[4] Myers A. NMS Medicina Interna. Cuarta Edición. México 2003. 697-703.

[5] Cotran R, Kumar V, Collins T. Robbins Patología Estructural y Funcional. Sexta edición. México 2000. 1299-1302.

[6] Jaramillo M, Godbout M, Naccache P, Oliver M. Signaling events involved in macrophage chemokine expression in response to monosodium urate crystals. J. Biol. Chem., Diciembre 10, 2004; 279(50):52797-52805.

[7] Bourgoin SG, Desaulniers P, Fernandes M, Gilbert C, Naccache PH. Crystal-induced neutrophil activation. VII. Involvement of Syk in the responses to monosodium urate crystals. J. Leukoc. Biol., Octubre 1, 2001; 70(4):659-68.

[8] Di Giovine FS, Duff GW, Malawista SE, Nuki G. Interleukin 1 (IL-1) as a mediator of crystal arthritis: stimulation of T-cell and synovial fibroblast mitogenesis by urate crystal-induced IL-1. J Inmunol 138:3213, 1987.

[9] Braunwald E, Fauci A, Kasper D, Hauser S, Jameson J, Longo D. Harrison Principios de Medicina Interna. Décimoquinta edición. México 2003. p. 2332-34.

[10] Emmerson BT. Drug therapy: the management of gout. N Engl J Med 1996; 334:445-51.

[11] Terkeltaub R. Gout. N Engl J Med 2003; 349:1647-1655, Oct 23, 2003.

[12] Dessein P, Joffe B, Ramokgadi J, Shipton E, Stanwix A. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann. Rheum. Dis, Jul 2000; 59:539-43.

[13] Burgos-Vargas R, Meoño Morales E, Pacheco-Tena C, Vázquez-Mellado J. Relation between adverse events associated with allopurinol and renal function in patients with gout. Ann. Rheum. Dis, Oct 2001; 60:981-83.

[14] Lin KC, Lin HY, Chou P. The interaction between uric acid level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study. J Rheumatol 2000; 27:1501-5.

[15] Caspi O, Lubart E, Graff E. The effect of mini-dose aspirin on renal function and uric acid handling in elderly patients. Arthritis Rheum 2000; 43:103-8.

[16] Rich MW. Uric acid: Is it a risk factor for cardiovascular disease? Am J Cardiol 2000; 85:1018-21.

[17] Niskanen LK, Laaksonen DE, Nyyssonen K. Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study. Arch Intern Med 2004; 164:1546-51.

[18] Wannamethee SG, Shaper AG, Whincup PH. Serum urate and the risk of major coronary heart disease events. Heart 1997; 78:147-53.

[19] Emmerson B. Hyperlipidaemia in hyperuricaemia and gout. Ann Rheum Dis 1998; 57:509-10.

[20] Fruehwald-Schultes B, Peters A, Kern W, Beyer J, Pfutzner A. Serum leptin is associated with serum uric acid concentrations in humans. Metabolism 1999; 48:677-80.

[21] Pascual E, Balllè-Gualda E, Martinez A. Synovial fluid analysis for diagnosis of intercritical gout. Ann Intern Med 1999; 131:756-9.

[22] Popp JD, Bidgood WO, Edwards NL. Magnetic resonance imaging of tophaceous gout in the hands and wrists. Semin Arthritis Rheum 1996; 25:282-9.

[23] Morris I, Varughese G, Mattingly P. Colchicine in acute gout. BMJ 2003; 327:1275-6.

[24] Clive DM. Renal transplant-associated hyperuricaemia and gout. J Am Soc Nephrol 2000; 11:974-9.

[25] Shoji A, Yamanaka H, Kamatani N. A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum 2004; 51:321-5.

[26] Riedel AA, Nelson M, Joseph-Ridge N, et al. Compliance with allopurinol therapy among managed care enrollees with gout: a retrospective analysis of administrative claims. J Rheumatol 2004; 31:1575-81.

[27] Takahashi S, Moriwaki Y, Yamamoto T, Tsutsumi Z, Ka T, Fukuchi M. Effects of combination treatment using anti-hyperuricemic agents with fenofibrate and/or losartan on uric acid metabolism. Ann Rheum Dis 2003; 62:572-5.

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