Multiple gouty tophi in a six-year-old

Abstract

Introduction: Gouty tophus in a child is an extremely rare presentation. Only very few cases have been documented in literature in contemporary times.
Case presentation: We present this index case of a 6-year-old child who was brought to the clinic by her parents on account of multiple subcutaneous swelling of two years’ duration on her lower limbs before she presented at our outpatient clinic. The swellings started from the knee joints and were associated with difficulty in walking. A provisional diagnosis of multiple soft tissue swelling was made before some of the swellings were excised. An excisional biopsy of some of the masses on the lower extremities was done, and histological examination revealed gouty tophus. She was then placed on oral febuxostat. Her clinical condition has improved significantly; she is on continuous follow-up at our facility's paediatric orthopaedic outpatient clinic. Hitherto, gouty tophus has been recorded in juveniles and young adults, but it may present in any child below the age of five years.
Conclusion: A high index of suspicion is needed in managing subcutaneous swellings in the paediatric age group (particularly pre-school) to identify and manage gouty tophus early enough to minimise its complications.