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Interphalangeal Joint Involvement of the Big Toe in Gout

A Rare Presentation

Michael Dobson Orthopaedics, Brighton and Sussex University Hospital, Brighton, Sussex, England. Mr. Dobson is now with Mid-Staffordshire NHS Trust, Stafford, England

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 FRCS (TrandOrth)
Yasir Alwahab Department of Pathology, Hammersmith Hospital, London, England

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Muhammad A. Fazal Chase Farm Hospital, Enfield, Middlesex, England

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 MBBS, FRCS (Eng), FRCS (TrandOrth)

Atypical presentation of gout can cause diagnostic dilemmas. We report a case of gout that presented with an expansile lytic lesion involving the interphalangeal joint of the hallux, lack of a history of gout, and an associated solitary lung nodule. Magnetic resonance imaging showed an expansile destructive bony lesion with soft-tissue involvement suggestive of a possible bony metastasis. A needle biopsy was performed, and histopathologic features were diagnostic of chronic tophaceous gout. (J Am Podiatr Med Assoc 102(3): 256–258, 2012)

Corresponding author: Muhammad A. Fazal, MBBS, FRCS (Eng), FRCS (Tr&Orth), Chase Farm Hospital, The Ridgeway, Enfield, Middlesex, EN2 8JL, England. (E-mail: malifazal@hotmail.com)