GRANULOMATOUS TOPHACEOUS GOUT MIMICKING TUBERCULOUS TENOSYNOVITIS - REPORT OF 2 CASES

Granulomatous inflammation in a tissue specimen raises concern about i nfection with Mycobacterium tuberculosis, atypical mycobacteria, certa in fungi, Brucella species, and other infectious agents. Inflammatory disorders, such as sarcoidosis, crystal-associated arthritis, or forei gn body reactions also are considered when granulomatous changes are s een on histological examination of a tissue specimen. We describe two cases of granulomatous tenosynovitis due to tophaceous deposits in pat ients with gout. In one case, tuberculous synovitis was considered the primary diagnosis until the diagnosis of gout was confirmed by examin ation of a tissue specimen with polarized light. In the second case, g out and tuberculosis were found in the patient's wrist joint. After an tituberculous therapy was discontinued, he continued to have wrist syn ovitis and chronic drainage due to granulomatous tophaceous gout. The findings in this report suggest that gouty tenosynovitis can mimic tub erculous tenosynovitis and that gout should be considered in the diffe rential diagnosis of granulomatous tenosynovitis, especially when acid -fast stains and cultures are negative for mycobacteria.