Gout is usually seen in the middle aged male. Onset before the age of 30 raise the question of an unusual form of gout. We report a case of gout initially occurring in a 16-year-old male. He was transferred to us at the age of 23 when multiple tophi could be seen at the elbow, wrist, hand, knee and ankle joints. Laboratory findings showed hyperuricemia and renal insufficiency. The patient was treated successfully with urinom, an uricosuric agent. He was also treated surgically by removing several tophi at the elbows and knee joints. An enzymatic study revealed an enzymatic defect resulting in overproduction of purine.
