Images in Clinical Medicine
Finger-Pad Tophi
N Engl J Med 2002; 346:1714May 30, 2002
- Article
Figure 1 A 57-year-old man presented with a three-month history of cream-yellow papules of 2 to 3 mm on the pulps of his fingers on both hands (Panel A) and on his right elbow (Panel B). Ten months earlier he had undergone bilateral lung transplantation and had since been receiving multiple medications, including cyclosporine and furosemide. The serum uric acid level was 10.2 mg per deciliter (607 μmol per liter). A lesion was scraped with a scalpel with a 15 blade and smeared onto a glass slide. Polarizing microscopy revealed multiple needle-shaped crystals that were bright yellow (Panel C) and were not birefringent. Films of both hands showed soft-tissue swelling and erosive bony changes in the wrists and interphalangeal joints. Treatment with colchicine and allopurinol was started. Three months later, there had been minimal improvement.
Komal F. Chopra, M.D.
9850 Genesee Ave., La Jolla, CA 92014Marc E. Grossman, M.D.
12 Greenridge Ave., White Plains, NY 10605- Citing Articles (2)
