A Case of Gouty Tophus of Distal Interphalangeal Joint of Index Finger

Abstract

Isolated gouty tophus in the hand is rare. We report a case of gouty tophus involving only the DIP joint of the index finger. An 85-year-old woman experienced pain and localized swelling of the DIP joint of the index finger. Radiograph revealed punched out lesion involving the DIP joint. Laboratory studies revealed BUN of 29 mg/dl, creatinine of 1.37 mg/dl and uric acid of 11.0 mg/dl. She had a long history of hypertension and angina pectoris, and had been treated with diuretic for 11 years. Conservative treatment with oral anti-inflammatories for three weeks prior to operation did not provide any improvement. At operation, chalk-like matter and osteolytic articular surface were curetted out and the DIP joint was fixed with Kirschner wires. Polarized light microscopy of the chalk-like matter showed variable-sized needle-shaped crystals. After the operation, oral administration of allopurinol reduced blood uric acid within normal limits. At the postoperative follow-up at eight months, the patient was asymptomatic. Renal dysfunction and 11-year oral diuretic there by is considered to be the main etiology of the gouty tophus of the finger.