Severe gouty tophi affect...

An 85-year-old male patient was admitted to a hospital via diabetic foot clinic with a rash and worsening renal function. He has a medical history of type 2 diabetes mellitus, hypertension, moderate left ventricular systolic dysfunction, paroxysmal atrial fibrillation, chronic kidney disease stage 3 and dyslipidemia. The patient had a non-blanching, palpable and purpuric rash on both legs extending to his abdomen. He was started on 30mg oral prednisolone once daily with a likely diagnosis of Henoch-Schönlein purpura and received intravenous fluid therapy in the initial days of his admission. His acute kidney injury (AKI) resolved during his 7-day inpatient stay. On the day of discharge, extensive gouty tophi affecting both of his hands were discovered, despite no prior history of taking medications or documented symptoms of gout. He had a raised serum urate level of 832 µmol/L and was diagnosed with gouty tophi.