Severe tophaceous gout is associated with renal impairment, alcohol, obesity, diet, hypertension, family history, and low socioeconomic status1,2. Treatment failure is estimated in about 1% to 1.5% of cases of gout in the United States3.
Our patient was a 60-year-old male with gouty arthritis for 15 years and chronic renal failure for 6 years. He described irregular usage of colchicine and urate-lowering …