Israel Medical Association Journal

A 65-year-old man had a long history of gout attacks, beginning at the age of 35 years. The disease was never well controlled. The patient did not follow diets, nor did he adhere to medication recommendations. He presented with systemic arterial hypertension, overweight (body mass index 29 kg/m²), and metabolic syndrome.

A 52-year-old man with a history of gout presented to the emergency department with painful purulent ulcers on the left index finger. Serum C-reactive protein was elevated to 112 mg/L. Hand radiographs [Figure 1A] demonstrated almost complete osteolysis of the two distal phalanges of the involved finger (asterisk), with multiple typical gouty erosions with sclerotic margins and overhanging edges in a marginal and juxta-articular distribution (white arrows), and soft tissue tophi (black arrows). Osteomyelitis of the index finger was suspected, and the finger was amputated.