Rare Case of Gout Leading to Septic Arthritis, Osteomyelitis, and Septic Shock in an Elderly Patient

Gout is a common, chronic inflammatory arthritis that oftentimes accompanies an initial acute and painful attack characterized by intense pain and swelling. Although it may present in different sites such as the ankles, wrists, knees, elbows, and fingers, the lower extremities are the most common site of involvement. The pathophysiology of gout is complex, but typically, the deposition of monosodium urate crystals within the joint space and the subsequent acute inflammatory response play an important role. Following an acute attack, chronic gout can present with tophi or nests of monosodium urate crystals surrounded by macrophages and multinucleated giant cells that trigger granulomatous inflammation. Progressively, chronic gout can lead to several other complications including joint destruction, gout nephropathy, spinal compression, and secondary infections. In this case report, we present an elderly female patient with chronic gout and multiple tophi formations in all digits of both of her hands. The tophi led to an ulceration and secondary septic arthritis and osteomyelitis of the right second digit. By the time the patient presented and was admitted to the hospital, she was in septic shock. We will review the pathogenesis of gout and other cases of concomitant septic arthritis and gout, as well as medical management and necessary surgical intervention as a means of treatment.