• Xiaoyan Jiang, Anxin Li, Wei Hao, Cheng Yang, Hongyan Wang, and Wuquan Deng.
• Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China.
• Medicine (Baltimore). 2024 May 17; 103 (20): e38137e38137.

IntroductionGout is a chronic disease characterized by deposition of monosodium urate crystals. Tophi develop in some individuals with untreated or uncontrolled gout, which leads to ulcerations, cosmetic problems, mechanical obstruction of joint movement, joint damage and musculoskeletal disability. Currently, the treatment of gouty tophi is controversial and challenging. Both surgical and internal medical treatments have limitations and require further exploration in clinical practice.Patient ConcernsIn Case 1, we treated a patient with severe infection of diabetic foot ulcers with concomitant multiple gouty tophi in the same limb. A systematic management strategy was formulated to close the wound and save the limb. The ulcers healed successfully after half a year. In Case 2, a giant gouty tophi located in the first metatarsophalangeal joint of the left foot was removed by surgical treatment and vancomycin-loaded bone cement implantation. In Case 3, we present a case of gouty tophi that was resolved by standardized systemic medical management.DiagnosisThree patients were all diagnosed with gout accompanied by gouty deposition, although there were other different comorbidities.InterventionsIn case 1, we used debridement to gradually remove gouty tophi. In case 2, the giant gouty tophi was removed by surgical operation. In case 3, the gouty tophi disappeared after standardized treatment with medicine, diet and lifestyle management.OutcomesThree patients underwent different treatment therapies to remove gouty tophi based on their specific conditions.LessonsWe explored effective interventions for tophi in gout by surgical or other interventions in combination with pharmacotherapy.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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