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-
1
Agudelo CA. Wise CM. Gout and hyperuricemia. Curr Opin Rheumatol 3: 684, 1991.
-
2
Cohen PR. Schmidt WA. Rapini RP. Chronic tophaceous gout with severely deforming arthritis: a case report with emphasis on histopathologic considerations. Cutis 48: 445, 1991.
-
3
Yu KH. Ho HH. Chen JY. et al: Gout complicated with necrotizing fasciitis: report of 15 cases. Rheumatology (Oxford) 43: 518, 2004.
-
4
Yu KH. Luo SF. Liou LB. et al: Concomitant septic and gouty arthritis: an analysis of 30 cases. Rheumatology (Oxford) 42: 1062, 2003.
-
5
Stapleton JJ. Rodriguez RH. Jeffries LC. et al: Salvage of the first ray with concomitant septic and gouty arthritis by use of a bone block joint distraction arthrodesis and external fixation. Clin Podiatr Med Surg 25: 755, 2008.
-
6
Lagoutaris ED. Adams HB. DiDomenico LA. et al: Longitudinal tears of both peroneal tendons associated with tophaceous gouty infiltration: a case report. J Foot Ankle Surg 44: 222, 2005.
-
7
Poratt D. Rome K. Surgical management of gout in the foot and ankle: a systematic review. JAPMA 106: 182, 2016.
-
8
Nakazawa F. Ishihara H. Tanaka K. A case of female premenopausal tophaceous gout requiring surgical management. Mod Rheumatol 14: 383, 2004.
Bilateral First-Ray Amputation of the Foot Due to Severe Tophaceous Gout Complicated by Infection and Discharged Sinus
A Case Report
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Background:
Gout is a purine metabolism disease. Tophaceous gout may cause joint destruction and other systemic problems and sometimes may be complicated by infection. Infection and sinus with discharge associated with tophaceous gout are serious complications, and treatment is difficult. We present a patient with tophaceous gout complicated by infection and discharging sinus treated by bilateral amputation at the level of the first metatarsus.
Methods:
A 43-year-old man previously diagnosed as having gout, and noncompliant with treatment, presented with tophaceous gout associated with discharging sinus and infection on his left first metatarsophalangeal joint. Because of the discharging sinus associated with the tophaceous deposits, the soft-tissue and bony defects, and the noncompliance of the patient, amputation of the first ray was undertaken, and a local plantar fasciocutaneous flap was used to close the defect. After 8 months, the patient was admitted to the emergency department with similar symptoms in his right foot, and the same surgical procedure was performed.
Results:
One year after the second surgery, the patient had no symptoms, there was no local inflammatory reaction over the surgical areas, and laboratory test results were normal.
Conclusions:
Gout disease with small tophi often can be managed conservatively. However, in patients with extensive lesions, risk of superinfection justifies surgical treatment. Results of complicated cases are not without morbidity; therefore, early surgical treatment may prevent extremity loss and further complications. In severe cases, especially with compliance issues, amputation provides acceptable results.
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