Acute Gouty Arthritis with Tophus Formation at the First Metatarsophalangeal Joint: A Case Report

Introduction: Gout is a crystal-induced arthropathy caused by monosodium urate (MSU) crystal deposition in joints and soft tissues due to chronic hyperuricemia.The first metatarsophalangeal (MTP) joint is the most commonly affected site.Although predominantly a medical condition, orthopedic surgeons often encounter its advanced presentations with joint destruction or tophus formation.Case presentation: We report the case of a 37-year-old male presenting with a painful swelling over the left first MTP joint, associated with tenderness and restricted movement.Laboratory evaluation revealed marked hyperuricemia (serum uric acid, 11.4 mg/dL) and mild renal function derangement.Radiography showed juxta-articular erosions with overhanging edges around the first MTP joint.Fine-needle aspiration cytology (FNAC) demonstrated needle-shaped crystalline deposits, confirming the diagnosis of acute gouty tophus.The patient was managed conservatively with febuxostat, corticosteroids, NSAIDs, and dietary modification, with progressive clinical improvement on follow-up.Conclusion: Multimodal evaluation including biochemical, radiological, and cytological assessment, ensures accurate diagnosis of gouty arthritis.Early institution of urate-lowering therapy prevents recurrence and joint damage.