An 85-year-old man was admitted to our hospital for swollen and painful bilateral lower legs and a high
fever. He was initially diagnosed with acute
cellulitis and treated with
antibiotics. Several days after the improvement of his swollen legs, he complained of both shoulder and arm
pain. The laboratory data at this time were as follow:
C-reactive protein 10.7 mg/dL,
uric acid 8.7 mg/dL, and
creatinine 1.07 mg/dL. Both
rheumatoid factor and
anti-CCP antibody were negative. Whole-body
gallium scintigraphy showed a high pathological accumulation in both the shoulders and left wrist. As
polymyalgia rheumatica was suspected, oral
prednisolone (PSL) of 10 mg/day was started. The patient's
shoulder pain improved and he was discharged. However, he was hospitalized twice in the next month because of left shoulder, left knee, right arm, and right wrist
pain. During the third hospitalization, we found a subcutaneous nodule on right toe. Aspiration material from the nodule was a white
paste, showing acicular crystals under the microscope. According to these findings, the nodule was diagnosed as a tophaceous nodule, and recurrent episodes of
polyarthritis were diagnosed as chronic tophaceous
gout. Low-dose PSL was continued and
febuxostat was added. This patient had multiple risk factors for chronic tophaceous
gout:
obesity, a habit of drinking,
diabetes mellitus,
hyperlipidemia,
congestive heart failure, and interruption of
allopurinol treatment. We herein discuss the
clinical course of the patient, the interruption of
allopurinol treatment and
polypharmacy in elderly patients.