Unusual Clinical Presentations of Gout

Tony C. Ning; Robert T. Keenan


Curr Opin Rheumatol. 2010;22(2):181 

In This Article

Visceral Gout

It seems the deposition of urate crystals have no boundaries. Gout has also presented in various organs, again masquerading as cancer or infection. A patient was documented with gout deposition in the pancreas.[49] The patient underwent imaging which revealed a large mass in the pancreatic tail. CT-guided biopsy was performed and it revealed a large collection of negatively birefringent needle-shaped crystals. The patient was treated with the appropriate serum urate lowering medications and a follow up CT scan 18 months later had revealed resolution of the pancreatic mass.

Gout has even been found on the heart valves. A pathology case report revealed tophaceous deposits on an aortic valve associated with stenosis.[50] There have been a few cases of tophi deposition on the mitral valve, as determined by imaging as well as pathology. The clinical presentation ranged from the patient being asymptomatic[51] to symptoms that were consistent-mitral stenosis.[52] Gout can also mimic infective endocarditis.[53] A 31-year-old patient was treated for infective endocarditis after developing a new pulmonic murmur in presence of a known brain abscess. Autopsy had revealed sterile tophi on the semi-lunar valve.

Gout has also presented as a solitary breast nodule.[54] The reported patient presented with a painless lump and histological examination of the removed mass revealed urate crystals. This presentation preceded any joint complaint, and was the patient's first clinical manifestation of gout.

Another case with unusual location of gout involved a 37-year-old woman who presented with nausea, vomiting, as well as abdominal pain.[55] The patient had a history of systemic lupus erythematous and had been on chronic prednisone. Imaging revealed a colonic mass, and fine-needle aspiration had confirmed the presence of a numerous urate crystals. A hemicolectomy was preformed, and although the colonic wall was normal on pathology, the mass proved consistent with tophi (Fig. 3).

Figure 3.

A cross-section of the transverse colon shows a cystic lesion in the subserosal wall of colon
The chalky white material was identified as gout. This is taken from: Wu H, et al. Intestinal pseudotumorous gouty nodulosis: a colonic tophus without manifestation of gouty arthritis. Hum Pathol 2004; 35:898. Figure 2.


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