J Korean Orthop Assoc.  2019 Feb;54(1):78-83. 10.4055/jkoa.2019.54.1.78.

Giant Tophi Involving Both Suprapatellar Pouches and Upper Poles of the Patellae: Treatment with Febuxostat and the 6 Years Follow-Up

• Kim ST
• Lee SY
• Kim SJ
• Kim BS

• KMID: 2438970
• DOI: http://doi.org/10.4055/jkoa.2019.54.1.78

Abstract

Tophi is one of the clinical manifestations of gout. On the other hand, it does not draw the patient's attention when it is asymptomatic, which leads to delayed management. The current case is a typical example of delayed diagnosis and management. The authors' preferred management of tophi was medical not surgical, even though the hitherto therapeutic issue has been conservative versus surgical. The authors chose conservative treatment in the osteolytic lesion resulting from huge tophi in the patella, and the report the results of 6 years follow-up.

Keyword

patella; giant gout tophi; osteolysis; medication

MeSH Terms

Delayed Diagnosis
Febuxostat*
Follow-Up Studies*
Gout
Hand
Osteolysis
Patella*
Febuxostat

Figure

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  Figure 1 (A) Gross findings of both knees shows the protruded upper pole of the right patella by huge tohi (arrow). (B) Simpe anteroposterior radiograph of both knees shows irregularly defined ring-shaped radiopaque shadows in the upper pole of both patellae. Lateral radipgraph shows the swollen soft tissue shadows with calcific spots in the upper poles of the right patella and eroded anterior cortices of the patella (arrows).

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  Figure 2 Sagittal and tangential views of a magnetic resonance imaging of the right knee showing a hypo-intense (T1) (A), hyper-intense (T2) (B), large mass in the supra-patellar pouches and upper poles of the patellae, with osteolytic lesion (C) in the superior patella region.

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  Figure 3 Needle biopsy showing white chalk-like material.

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  Figure 4 Polarizing microscopy image (×400) showing a birefringent needle shaped urate crystal (arrows).

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  Figure 5 Tophi crystals are surrounded by inflammatory cells including macrophages, lymphocytes, foreign body giant cells (H&E, ×400).

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  Figure 6 Radiographs at one week later (A), 2 years later (B), 4 years later (C), 6 years later (D). After 4 years, the tophi size decreased and the osteolytic lesion was filled with new bone (arrows).

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