Severe tophaceous gout in the setting of myelofibrosis: A clinical challenge

We illustrate a case of a patient with a history of myelofibrosis, presenting with a clinical picture of presumed infection. Imaging revealed apparent fluid collections and erosions in the ankle/foot, supporting the clinical suspicion of infection. However, operative findings revealed extensive tophaceous gout, likely a consequence of long-standing myelofibrosis. It is important to be aware of this atypical presentation of gout in patients with myelofibrosis.