Atypical deposition of cholesterol crystals under the mask of gouty tofus
Authors:
Company: V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
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Type: Case reports
DOI:
For citation: Eliseev M.S., Kuzmina Ya.I. Atypical deposition of cholesterol crystals under the mask of gouty tofus. Creative Cardiology. 2025; 19 (4): 501–505 (in Russ.). DOI: 10.24022/1997-3187-2025-19-4-501-505
Received / Accepted: 09.09.2025 / 29.09.2025
Keywords: cholesterol cholesterol crystals hyperlipidemia arthrocentesis gout tophus
Abstract
Damage to the musculoskeletal system in hyperlipidemia is quite common, and is usually asymptomatic. However, extra- articular localization of cholesterol crystals in the foot joints is rare, especially in the absence of other xanthomas in typical locations. Hypercholesterolemic arthritis is even less common. Our article presents a case of atypical formation of a huge xanthoma in a 49-year-old patient in the area of the 1-st metatarsophalangeal joint (MTP1), simulating the topus in gouty arthritis. In this case, the exclusion of gout was of paramount importance, considering the presence of hyperuricemia in the blood and the “classical” involvement of MTP1. The diagnosis of arthritis associated with cholesterol crystals was eventually verified using the “gold standard” diagnosis of microcrystalline arthritis – arthrocentesis.References
- Shattat G.F. A review article on hyperlipidemia: Types, treatments and new drug targets. Biomed. Pharmacol. J. 2014; 7: 399–409. DOI: 10.13005/bpj/504
- Pietroleonardo L., Ruzicka T. Skin manifestations in familial heterozygous hypercholesterolemia. Acta Dermatovenerol. Alp. Pannonica. Adriat. 2009; 18 (4): 183–187.
- Agarwal S., Akhtar M.N. Great toe gouty tophus-like lesion revealing extensive tendon xanthomatosis in a asymptomatic hyperuricemic patient. J. Postgrad. Med. 2013; 59 (3): 238–239. DOI: 10.4103/0022-3859.118054
- Thissen C.A., Frank J., Lucker G.P. Tophi as first clinical sign of gout. Int. J. Dermatol. 2008; 47 Suppl. 1: 49–51. DOI: 10.1111/j.1365-4632.2008.03961.x
- Koley S., Salodkar A., Choudhary S., Bhake A., Singhania K., Choudhury M. Tophi as first manifestation of gout. Indian J. Dermatol. Venereol. Leprol. 2010; 76 (4): 393–396. DOI: 10.4103/0378-6323.66593
- Ettlinger R.E., Hunder G.G. Synovial effusions containing cholesterol crystals report of 12 patients and review. Mayo Clin. Proc. 1979; 54 (6): 366–374.
- Dieppe P., Swan A. Identification of crystals in synovial fluid. Ann. Rheum. Dis. 1999; 58 (5): 261–263. DOI: 10.1136/ard.58.5.261
- Rasheed H., Hughes K., Flynn T.J., Merriman T.R. Mendelian randomization provides no evidence for a causal role of serum urate in increasing serum triglyceride levels. Circ. Cardiovasc. Genet. 2014; 7 (6): 830–837. DOI: 10.1161/CIRCGENETICS.114.000556
- Kuwabara M., Borghi C., Cicero A.F.G., Hisatome I., Niwa K., Ohno M. et al. Elevated serum uric acid increases risks for developing high LDL cholesterol and hypertriglyceridemia: A five-year cohort study in Japan. Int. J. Cardiol. 2018; 261: 183–188. DOI: 10.1016/j.ijcard.2018.03.045
- Mathon G., Gagné C., Brun D., Lupien P.J., Moorjani S. Articular manifestations of familial hypercholesterolaemia. Ann. Rheum. Dis. 1985; 44 (9): 599–602. DOI: 10.1136/ard.44.9.599
- Klemp P., Halland A.M., Majoos F.L., Steyn K. Musculoskeletal manifestations in hyperlipidaemia: a controlled study. Ann. Rheum. Dis. 1993; 52 (1): 44–48. DOI: 10.1136/ard.52.1.44
- Padhan P., Pradhan P., Mohanty I. Hypercholesterolemic arthritis in a young female. Eur. J. Rheumatol. 2020; 7 (2): 96–97. DOI: 10.5152/eurjrheum.2019.19033
- Sugimoto T., Sakuda T., Hirata S. Cholesterol Crystal-induced Arthritis. Intern. Med. Published online November 21, 2024. DOI: 10.2169/internalmedicine.4500-24
