Images in Clinical Medicine

Finger-Pad Tophi

Komal F. Chopra, M.D., and Marc E. Grossman, M.D.

N Engl J Med 2002; 346:1714May 30, 2002

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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 92014

Marc E. Grossman, M.D.
12 Greenridge Ave., White Plains, NY 10605

Citing Articles (4)

Citing Articles

1. 1

   C. Meseguer-Yebra, C. Martínez-Morán, A. Romero-Maté, A. Moreno, D. Arias-Palomo, J. Borbujo. (2012) Joint destruction and presence of small papules on the palms and soles. Clinical and Experimental Dermatology 37:4, 450-452
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2. 2

   Lindsy J. Forbess, Theodore R. Fields. (2012) The Broad Spectrum of Urate Crystal Deposition: Unusual Presentations of Gouty Tophi. Seminars in Arthritis and Rheumatism
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3. 3

   Tristan Pascart, René-Marc Flipo. (2011) La goutte: présentations cliniques et diagnostic. Revue du Rhumatisme 78, S116-S121
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4. 4

   Pascal Richette, Thomas Bardin. (2010) Gout. The Lancet 375:9711, 318-328
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