Multiarticular tophaceous gout with severe joint destruction: a pictorial overview with a twist.
Bottom Line: X-rays of hands and feet showed dramatic destructive changes.The patient presented with mottled hypopigmentation on anterior and posterior knees and dorsa of hands and feet where he applied hot "aankda" leaves and covered them with bandage resulting in irritant dermatitis with postinflammatory hypopigmentation.This proved to be a red herring in this case.
Affiliation: In Skin Clinic, Vadodara, Gujarat, India.
Tophi are the visible dermatological signs of gout. A case of tophaceous gout in a middle-aged man with no other metabolic derangement is being presented with multiple tophi on the hands and feet overlying joints as well as on the fingers and toes. We thought it to be of educational value to demonstrate needle-like crystals of urate by polarizing microscopy. X-rays of hands and feet showed dramatic destructive changes. The patient presented with mottled hypopigmentation on anterior and posterior knees and dorsa of hands and feet where he applied hot "aankda" leaves and covered them with bandage resulting in irritant dermatitis with postinflammatory hypopigmentation. This proved to be a red herring in this case.
No MeSH data available.
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Mentions: A 45-year-old man, a fruit cart puller by profession, was referred to this clinic by a nephrologist for multiple nodules on his hands and feet and mottled pigmentation on knees, popliteal fossae, and dorsa of hands and feet with a diagnosis of multiple renal calculi and raised creatinine. He was vegetarian and a teetotaler. He was normoglycemic and normotensive. He had multiple asymptomatic skin-colored nodules overlying joints and many of them were superficially located [Figure 1]. Smaller ones were grouped on the dorsolateral aspect of the fingers and toes and had a yellowish white look. Patient said that one on the right index finger had spontaneously burst twice exuding a thick white chalky discharge [Figure 2]. There was no clinical evidence of psoriasis or psoriatic arthritis. There was mottled pigmentation on his knees, popliteal fosseae, [Figure 5a and 5b] and dorsa of hands and feet. His joint complaints started about 6 years ago with pain in the knees and then on the wrists, fingers, and toes. An initial diagnosis of osteoarthritis was made and he was prescribed diclofenac and paracetamol. During the acute bouts of arthritis he applied heated leaves of ‘aakda’ plant (calotropis gigantea) on his feet, hands, and knees; is the leaves used by villagers as a pain killer by securing them with a bandage.
No MeSH data available.