Severe multiarticular gouty tophi

Tophaceous gout is a chronic, advanced manifestation of gout, characterized by subcutaneous and periarticular deposition of monosodium urate crystals, leading to the formation of tophi. While modern urate-lowering therapies have reduced the incidence of tophaceous disease, it still occurs in patients with delayed diagnosis, nonadherence to treatment, or inadequate medical follow-up. We present the case of a 62-year-old male admitted with an acute ischemic stroke, which led to the incidental discovery of his advanced, untreated tophaceous disease. He was found to have extensive tophaceous involvement of multiple joints and soft tissues, including disfiguring nodules on the hands, elbows, and forearms. Management of tophaceous gout hinges on sustained urate-lowering therapy and careful monitoring to prevent irreversible joint damage. This report underscores the long-term consequences of untreated gout and the critical importance of early diagnosis and lifelong adherence to medical therapy.