Ahmet Fevzi KEKEÇ, Bilgin BOZGEYİK, Selçuk YILMAZ

Unusual Presentation of Bilaterally Symmetrical Gout Tophi on Elbows

Gout is a crystal deposition rheumatic disease. It is a more common inflammatory arthritis in men, characterized by formation ofmonosodium 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 thelast 4 years. Radiographs of both the elbows showed soft tissue swellings with no involvement of bones. Masses were of intermediatesignal intensity on T1-weighted magnetic resonance images and high signal intensity on T2-weighted images. Fine needleaspiration cytology was performed in masses on both the elbows. Light microscopy of the Giemsa- and Papanicolaou-stainedsmears demonstrated abundant granular amorphous material and scattered stacks of slender needle-shaped crystals, associatedwith chronic inflammatory infiltrate. Based on the above findings, a diagnosis of gout tophi was made. After informed consentwith the patient under general anesthesia, marginal resection of tophi were performed in the same session with clear margins. Wedescribe the treatment of a patient with long-standing chronic gout tophus located bilaterally at the elbow joint complicated bybursal deposit with rapid progression during the last 4 years. To the best of our knowledge, our case presentation may be the firstcase report where huge tophi were symmetrical and bilaterally presented on both the elbows.

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