Speaker Credentials
OMS-II
College
Dr. Kiran C. Patel College of Osteopathic Medicine, DO
Medical Specialty
Dermatology
Format
Poster
Start Date
November 2024
End Date
November 2024
Track
3
Abstract
Introduction. This case report discusses the pathophysiology of gout, the relationship between gouty tophi and rapid renal decline, and the treatment challenges posed by overlapping co-morbidities, like chronic kidney disease, and the updated guidelines for managing gout. Deviation from the Expected. Podagra is only initially present in about 50% of patients with gout and therefore its absence, as was the case in our patient, should not be used to rule out the condition. Case Presentation. We present a 63-year-old Caucasian male with a history of hypertension and chronic kidney disease on dialysis, who appeared with multiple subcutaneous nodules on his arms and legs. The nodules had been present for 14 years, remained generally firm, but occasionally softened and became painful. Discussion. Given the ultrasound imaging findings and punch biopsies of the nodules, findings were consistent with gouty tophi. This was supported by the patient's history of hyperuricemia and chronic kidney disease, which are risk factors for gout. Conclusion. Gout is one of the most common forms of arthritis worldwide, affecting men and the elderly the most. The relationship between gout and its co-morbidities, such as chronic kidney disease, is complex and bidirectional. For example, the tophaceous form of gout has been linked to a rapid decline in renal function and vice versa. While previously called into question, current guidelines on the management of gout have been significantly improved. Care should be taken not to misdiagnose gout with pseudogout, a common imitator.
Included in
Dermatology Commons, Nephrology Commons, Rheumatology Commons
Extensive Gouty Tophi in a Patient on Dialysis
Introduction. This case report discusses the pathophysiology of gout, the relationship between gouty tophi and rapid renal decline, and the treatment challenges posed by overlapping co-morbidities, like chronic kidney disease, and the updated guidelines for managing gout. Deviation from the Expected. Podagra is only initially present in about 50% of patients with gout and therefore its absence, as was the case in our patient, should not be used to rule out the condition. Case Presentation. We present a 63-year-old Caucasian male with a history of hypertension and chronic kidney disease on dialysis, who appeared with multiple subcutaneous nodules on his arms and legs. The nodules had been present for 14 years, remained generally firm, but occasionally softened and became painful. Discussion. Given the ultrasound imaging findings and punch biopsies of the nodules, findings were consistent with gouty tophi. This was supported by the patient's history of hyperuricemia and chronic kidney disease, which are risk factors for gout. Conclusion. Gout is one of the most common forms of arthritis worldwide, affecting men and the elderly the most. The relationship between gout and its co-morbidities, such as chronic kidney disease, is complex and bidirectional. For example, the tophaceous form of gout has been linked to a rapid decline in renal function and vice versa. While previously called into question, current guidelines on the management of gout have been significantly improved. Care should be taken not to misdiagnose gout with pseudogout, a common imitator.