Tophi as first clinical sign of gout.

Gout results from deposition of monosodium urate crystals in different body tissues, including the skin and soft tissues. With increasing prosperity a rising prevalence of the disease can be observed, especially in highly industrialized countries. Gout can present with acute and painful attacks of arthritis that can affect several joints. In addition, nodular masses of uric acid crystals can develop, which are referred to as tophi. Although tophaceous gout usually is a sign of long during and chronic disease tophi can also occur as first symptom of the disorder. Here, we report on an 85-year-old woman who was diagnosed with tophaceous gout devoid of a prior medical history of the disease.