Volume 215 - Issue 5
Chalky urate in a patient with bullous tophi
Authors: Hsi Yen, Hsing‐Jou Su and Wei‐Ti Chen
Med J Aust 2021; 215 (5): 209-209.e1. || doi: 10.5694/mja2.51215
Published online: 6 September 2021
Published online: 6 September 2021
An 86-year-old man presented with multiple, asymptomatic tense, white bullae over bilateral toes one week after a resolved episode of acute gouty arthritis
An 86‐year‐old man presented with multiple, asymptomatic tense, white bullae over bilateral toes (Figure, A) one week after a resolved episode of acute gouty arthritis. White, chalk‐like material expressed from the bullae demonstrated monosodium urate crystals that exhibited strong negative birefringence by light microscopy (Figure, B; the white arrow shows the axis of the red compensator). Bullous tophi are an unusual presentation of gout. As patients can be asymptomatic with normal serum urate concentrations, diagnosis is aided by identifying monosodium urate crystals from chalky urate.1 Manual compression was done to drain the bullae after making a superficial needle puncture, and urate‐lowering therapy prevented recurrence.
Competing interests
No relevant disclosures.
References
- Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet 2016; 388: 2039–2052.
Patterns of Osteoporosis Treatment Initiation Following Low-Trauma Fracture: A Population-Based Retrospective Cohort Study in New South Wales, Australia, Using Linked Administrative Health Data
Mike Lin, Huy Nguyen, Thach Tran, Robert D. Blank, Dana Bliuc, Jacqueline R. Center
Rapid Growth in Diagnostic CT Knee Imaging in Australia: Implications for Imaging Stewardship
Hanwen Chen, Rachelle Buchbinder, Sean Docking, Ian A Harris
Spinal cord stimulation patterns of care, re‐interventions, and costs for private health insurers, Australia, 2011–22: a retrospective observational study
Caitlin MP Jones, Christopher G Maher, Rachelle Buchbinder, Ian A Harris, Chung‐Wei Christine Lin, Christopher Hayes, Alexandra Gorelik
The incidence of and risk factors for hospitalisations and amputations for people with diabetes‐related foot ulcers in Queensland, 2011–19: an observational cohort study
Yuqi Zhang, Susanna M Cramb, Steven M McPhail, Rosana Pacella, Jaap J Netten, Ewan M Kinnear, Peter A Lazzarini
Bone health perspectives among Indigenous people: a qualitative study
Troy Walker (Yorta Yorta), Karan P Singh, Vanessa Gan, Brooke Conley (Ngiyampaa), Jessica Bravo, Nigel Smith (Weilwan), April Clarke (Eastern Maar, Kirrae Whurrung, Djap Wurrung), Jackson Baker, Louise J Maple‐Brown, Robin M Daly, Jennifer Browne, Jesse Zanker, Cat Shore‐Lorenti, David Scott, Peter R Ebeling, Ayse Zengin
I am a Civil War
Jennifer G Mowbray