Case report of a tibial fracture in a patient suffering from gout: An atypical site, the importance of differential diagnosis1,2

We present the case of a 60-year-old man with a history of severe tophaceous gout with polyarticular involvement who came to the emergency room due to direct trauma to the right forearm and knee. The knee X-ray and CT scan showed a lateral tibial plateau fracture characterized by the presence of a lytic bone lesion. The presence of a solid neoplasm was ruled out and a CT-guided biopsy was performed. Histological evaluation revealed findings typical for an advanced intraosseous gout. As there was no significant risk of progression of the lytic lesion, the fracture site was treated conservatively. This case is unique in the literature in terms of location and should be considered as an atypical site of intraosseous gout. Proper differentiation of a pathological fracture on an intraosseous gout location from a neoplastic lesion is essential to choose the correct therapy.