A case of female premenopausal tophaceous gout requiring surgical management

We report a case of tophaceous gout in a 32-year-old woman who had suffered from anorexia nervosa since the age of 15. She had been taking a diuretic, mainly furosemide, to lose weight since she was 18. She was referred for orthopedic surgery because of a tophus at her right metatarsophalangeal joint. Because of a discharging sinus associated with the tophaceous deposits, surgery was performed. Use of the diuretic was stopped after surgery and the serum uric acid concentration returned to normal. It was thought that long-term abuse of a diuretic induced the tophaceous gout in this premenopusal woman.