Clinical images: Divergent patterns of joint remodeling following effective urate-lowering therapy in tophaceous gout.

摘要

The patient, a 35-year-old man, presented with severe tophaceous gout and hyperuricemia (10.2 mg/dl), despite receiving combination treatment with allopurinol (300 mg daily) and benzbromarone (100 mg daily). He had a history of renal transplantation and was treated with cyclosporine; his serum creatinine level was 2.07 mg/dl. During a prolonged hospital admission in 2007 for treatment of an infected tophus affecting the calf, monthly administration of rasburicase (1) was initiated, leading to normalization of the serum urate levels (3.8-6.0 mg/dl) and a gradual reduction in tophus size.