Unusual Presentation of Bilaterally Symmetrical Gout Tophi on Elbows

Abstract

Gout is a crystal deposition rheumatic disease. It is a more common inflammatory arthritis in men, characterized by formation of monosodium urate crystals in the synovial fluid of joints and in other tissues. It commonly deposits in the feet, ankles, knees, hands, wrists, and elbows. A 54-year-old male presented with big symmetrical masses developed gradually on both the elbows over the last 4 years. Radiographs of both the elbows showed soft tissue swellings with no involvement of bones. Masses were of intermediate signal intensity on T1-weighted magnetic resonance images and high signal intensity on T2-weighted images. Fine needle aspiration cytology was performed in masses on both the elbows. Light microscopy of the Giemsa- and Papanicolaou-stained smears demonstrated abundant granular amorphous material and scattered stacks of slender needle-shaped crystals, associated with chronic inflammatory infiltrate. Based on the above findings, a diagnosis of gout tophi was made. After informed consent with the patient under general anesthesia, marginal resection of tophi were performed in the same session with clear margins. We describe the treatment of a patient with long-standing chronic gout tophus located bilaterally at the elbow joint complicated by bursal deposit with rapid progression during the last 4 years. To the best of our knowledge, our case presentation may be the first case report where huge tophi were symmetrical and bilaterally presented on both the elbows.