Multiple Gouty Tophi with Bone Erosion and Destruction: A Report of an Early-onset Case in an Obese Patient

  • D Hayashi Reiko
    Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
  • Yamaoka Masaya
    Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
  • Nishizawa Hitoshi
    Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
  • Fukuda Shiro
    Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
  • Fujishima Yuya
    Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
  • Kimura Takekazu
    Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
  • Kozawa Jyunji
    Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
  • Kita Shunbun
    Department of Metabolism and Atherosclerosis, Graduate School of Medicine, Osaka University, Japan
  • Matsuoka Taka-aki
    Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
  • Otsuki Michio
    Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
  • Imagawa Akihisa
    Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
  • Ichida Kimiyoshi
    Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Japan
  • Taniguchi Atsuo
    Institute of Rheumatology, Tokyo Women's Medical University, Japan.
  • Maeda Norikazu
    Department of Metabolism and Atherosclerosis, Graduate School of Medicine, Osaka University, Japan
  • Funahashi Tohru
    Department of Metabolism and Atherosclerosis, Graduate School of Medicine, Osaka University, Japan
  • Shimomura Iichiro
    Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan

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Abstract

<p>A 27 year-old severely obese man (BMI, 35.1) had hyperuricemia and multiple gouty tophi with bone erosion and destruction, resulting in gait disturbance for 6 years after the early onset of gout at 21 years of age. His hyperuricemia was associated with hyperinsulinemia in obesity and a genetic variant of the ABCG2 gene. In addition, multiple gouty tophi with bone erosion and destruction might have been caused by hypoadiponectinemia and the elevation of the patient' s pro-inflammatory cytokine (IL-1β) level with the accumulation of visceral fat. In this case, bone and Ga-67 scintigraphy were useful for detecting the location and magnitude of gouty tophi. </p>

Journal

  • Internal Medicine

    Internal Medicine 56 (9), 1071-1077, 2017

    The Japanese Society of Internal Medicine

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