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Rheumatology
Atypical presentation of gouty tophi in a resource-limited setting
  1. Issakwisa Habakkuk Mwakyula1,2,
  2. Gloria Reginald Mbwile3,4,
  3. Liset M Torres5,6 and
  4. Baraka Michael Chaula7,8
  1. 1 Department of Internal Medicine, Mbeya Zonal Referral Hospital, Mbeya, United Republic of Tanzania
  2. 2 Department of Internal Medicine, University of Dar es Salaam Mbeya College of Health and Allied Sciences, Mbeya, United Republic of Tanzania
  3. 3 Department of Pediatric and Child Health, University of Dar es Salaam Mbeya College of Health and Allied Sciences, Mbeya, United Republic of Tanzania
  4. 4 Department of Pediatric and Child Health, Mbeya Zonal Referral Hospital, Mbeya, United Republic of Tanzania
  5. 5 Department of Pathology, Mbeya Zonal Referral Hospital, Mbeya, United Republic of Tanzania
  6. 6 Department of Pathology, University of Dar es Salaam Mbeya College of Health and Allied Sciences, Mbeya, United Republic of Tanzania
  7. 7 Department of Internal Medicine, Dermatology Unit, Mbeya Zonal Referral Hospital, Mbeya, United Republic of Tanzania
  8. 8 Department of Internal Medicine, Dermatology Unit, University of Dar es Salaam Mbeya College of Health and Allied Sciences, Mbeya, United Republic of Tanzania
  1. Correspondence to Dr Issakwisa Habakkuk Mwakyula; ozzanne{at}gmail.com

Abstract

A man in his early 50s from Tanzania presented with chronic nodular skin lesions and joint pain, likely due to gout complicated by obesity, after over 15 years of misdiagnosis and ineffective treatment. Despite various therapies for leprosy, tuberculosis and steroid use, his condition worsened, leading to hyperglycaemia and significant financial strain. Missed opportunities to use simple, low-cost diagnostic tests such as ultrasound and examining nodule fluid for urate crystals led to delays in diagnosis. Instead, unnecessary tests were performed, increasing costs without aiding diagnosis. This case highlights the need to use simple, available diagnostic tests in resource-limited settings before relying on costly investigations that can impose a heavy financial burden on patients. Likewise, it emphasises recognising atypical presentations of gouty tophi, such as isolated soft tissue involvement without joint involvement.

  • Rheumatology
  • Obesity (public health)

https://doi.org/10.1136/bcr-2024-263343

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    Footnotes

    • X @ozzanne

    • Contributors IHM is the guarantor of this work and accepts full responsibility for the overall content, access to all relevant data and the decision to publish. IHM, GRM, LMT and BMC were responsible for drafting the manuscript, sourcing and editing clinical images, reviewing investigation results and preparing original figures and tables. They also contributed to critical revisions for important intellectual content. All authors gave the final approval of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.