Abdominal Abscess as a Rare Manifestation of Gout

Gout is a common inflammatory arthritis in adults. Elevated levels of uric acid lead to the formation of monosodium urate crystals and their deposition in joints, and rarely, other parts of the body. The tissues most frequently involved are synovium, bone, cartilage, skin, tendon, ligament, and kidney. Here, we report an unusual presentation of gout manifesting as an abdominal abscess. A 60-year-old man with a history of opioid abuse, hypertension, and knee gouty arthritis presented to the emergency department with severe right knee pain. During hospitalization, he complained of pain in the left lower abdominal quadrant and developed coffee-ground emesis. Computed tomography showed pneumoperitoneum. The patient underwent laparotomy and was found to have gastric perforation and a large abdominal abscess. Drainage of the abscess revealed necrotic and hemorrhagic fragments of omentum. Microscopic examination showed adipose tissue with fat necrosis, acute inflammation, and fungal hyphae. Eosinophilic, amorphous deposits of polarizable needle-shaped crystals were observed in all sections, indicating the presence of monosodium urate crystals. The combined characteristics suggested intra-abdominal gout with concurrent fungal infection resulting from gastric perforation. This presentation is very rare. Only one occurrence of intra-abdominal gout mimicking a pelvic abscess has been reported in the literature.