Atypical deposition of cholesterol crystals under the mask of gouty tofus

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.