case_images: PMC5586733_01
case_images: Diffuse swelling with pitting edema (arrow) on the dorsum of the left hand on arrival.
case_images: mpp-0022-0307-g01.jpg
case_images: PMC5586733_01_mpp-0022-0307-g01.jpg
case_images: F1
case_images: Upon examination, his body temperature was 38.1 C and local examination revealed swelling with pitting edema on the dorsum of his hands and feet bilaterally with surrounding erythema and local warmth (fig. 1).
case_images: Magnetic resonance imaging of the left hand reveals marked edematous, inflammatory change with diffuse enhancement around the extensor tendons (arrows) on coronal (a) and sagittal (b) gadolinium-enhanced T1-weighted fat-suppression images.
case_images: mpp-0022-0307-g02.jpg
case_images: PMC5586733_01_mpp-0022-0307-g02.jpg
case_images: F2
case_images: T1-weighted fat-suppression imaging, around the extensor tendons (fig. 2). The synovial fluid aspirated from his left wrist joint demonstrated both monosodium urate (MSU) and calcium pyrophosphate dehydrate (CPPD) crystals on polarized light microscopic examination.
case_images: Gouty tophus of the left auricle (arrow).
case_images: mpp-0022-0307-g03.jpg
case_images: PMC5586733_01_mpp-0022-0307-g03.jpg
case_images: F3
case_images: Moreover, a tophus was found in his left auricle (fig. 3) and resection biopsy detected MSU crystals.