The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi

Semin Arthritis Rheum. 2012 Oct;42(2):146-54. doi: 10.1016/j.semarthrit.2012.03.007. Epub 2012 Apr 21.


Objectives: Gout is typically described as an inflammatory arthropathy that affects the peripheral joints. Our aim was to describe atypical and rare clinical presentations of gouty tophi to help increase physician awareness and aid in patient care.

Methods: The relevant English literature of unusual gout manifestations was searched using the keywords gout, toph*, monosodium urate, uric acid, unusual, and rare. Well-described case reports, case series, and review articles were evaluated and included, if relevant, in the literature review.

Results: Review of the literature revealed many unusual manifestations of gouty tophi involving the head and neck, skin, viscera, bones, tendons, ligaments, nerves, and axial skeleton. Transplant recipients, women, and elderly people are particularly susceptible to developing tophi. Furthermore, gout can cause diagnostic dilemmas, as it can be a great mimicker of and can coexist with infection, malignancy, and other connective tissue diseases. Imaging modalities can help detect tophi in atypical locations.

Conclusions: Tophi can present in unexpected locations, even as the first sign of gout, and vigilance is required when unusual symptoms or signs occur in a patient with gout.

Publication types

  • Review

MeSH terms

  • Arthritis, Gouty / diagnosis*
  • Arthritis, Gouty / metabolism
  • Crystallization
  • Diagnosis, Differential
  • Female
  • Humans
  • Joints / pathology
  • Male
  • Sex Factors
  • Uric Acid / chemistry
  • Uric Acid / metabolism*


  • Uric Acid