Objective:

To explore the relationship between longstanding tophaceous gout and bilateral Achilles tendon rupture in a patient.

Approach:

• Patient Case Description: A 68-year-old male with poorly controlled tophaceous gout presented with bilateral Achilles tendon rupture after recent fluoroquinolone exposure.
• Clinical Findings: MRI confirmed bilateral Achilles tendon rupture and extensive intratendinous tophaceous deposition.
• Proposed Mechanism: A 'two-hit' model was proposed, suggesting chronic gout weakened tendons, while fluoroquinolone exposure contributed to rupture.

Key Findings:

• The patient had a serum urate concentration of 9.6 mg/dL.
• MRI revealed complete bilateral Achilles tendon ruptures with significant tendon retraction.
• Chronic intratendinous tophaceous gout may lead to tendon degeneration.

Limitations:

• Causal relationship between fluoroquinolone exposure and tendon rupture could not be established.
• Findings may not be generalizable to all gout patients or those on fluoroquinolones.

Sources:

• ACR Open Rheumatology