case_images: PMC10481838_01
case_images: Clinical photographs of patient's bilateral feet (a), bilateral hands (b), and front view of the right hand (c) demonstrating multiple tophaceous swellings involving various joints of hands and feet.
case_images: SNI-14-294-g001.jpg
case_images: PMC10481838_01_SNI-14-294-g001.jpg
case_images: F1
case_images: On physical examination, he had multiple hard, nodular swellings consistent with tophi in his hands and feet, including 0.5 cm tophi involving both big toes and the right little toe, a large 1.4 cm tophus involving the right middle finger, a 1 cm tophus on the right ring, and a 0.8 cm tophus at the right wrist [Figures 1 a-c]. There were also numerous 0.5 cm tophi noted involving the inter-phalangeal joints of the left hand [Figure 1b].
case_images: Sagittal views of magnetic resonance imaging lumbosacral spine of the patient showing right sagittal cut (a), midsagittal cut (b), and left sagittal cut (c).
case_images: SNI-14-294-g002.jpg
case_images: PMC10481838_01_SNI-14-294-g002.jpg
case_images: F2
case_images: Added hyperintensities were also noted bilaterally adjacent to the spinous processes of L3 through L5 [Figures 2 and 3].
case_images: Axial views of the magnetic resonance imaging lumbosacral spine at (a) L3-4, (b) L4-5, and (c) L5-S1 levels of the patient. The green arrow in (a) is demonstrating the thickening of the spinous process noted at the L3-4 level. The yellow arrow in (b) demonstrates a hyper-intense signal in the left paraspinal region.
case_images: SNI-14-294-g003.jpg
case_images: PMC10481838_01_SNI-14-294-g003.jpg
case_images: F3
case_images: Added hyperintensities were also noted bilaterally adjacent to the spinous processes of L3 through L5 [Figures 2 and 3].
case_images: Photograph of the specimen excised intraoperatively demonstrating tophi along with bony tissue.
case_images: SNI-14-294-g004.jpg
case_images: PMC10481838_01_SNI-14-294-g004.jpg
case_images: F4
case_images: Intraoperatively, thickened yellow ligament and hypertrophied facet joints and spinous processes were removed along with multiple tophaceous nodules [Figure 4].