Microscopic needles in a painful elbow swelling -A case report of Atypical Gout

Abstract

A nodular subcutaneous swelling at elbow in an elderly patient should raise suspicion of infection or malignancy. A 63 year male patient presented with painful swelling in right elbow which was present for two years. It was insidious in onset and gradually increased to the present size. Clinical examination revealed a 6x5x5cm soft swelling, compressible, non-reducible, tender and overlying skin was pinch able. The uric acid level was 8.3mg/dl which was within normal limit. Patient complained that pain worsened on intake of alcohol and used to subside upon medication. The main clinical differential diagnosis were bursitis and gouty arthritis. On histopathological examination it revealed Gouty arthritis after ruling out granulomatous inflammation, foreign body giant cell reaction.

Keywords: Gouty arthritis, uric acid, elbow, histopathology