The Broad Spectrum of Urate Crystal Deposition: Unusual Presentations of Gouty Tophi

Seminars in Arthritis and Rheumatism, 04/25/2012

Forbess LJ et al. – 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.


  • 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.


  • 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.

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