Development of gouty tophi in the myocardium, complicated by a purulent-necrotic process

Abstract

Gout is a systemic disease characterized by the deposition of sodium monourate crystals in various tissues with the development of chronic inflammation and hyperuricemia. A rare case of the development of gouty tophi in the myocardium complicated by a purulent-necrotic process in a patient with gout is presented. Case description. The corpse of L.P., 30 years old, was found at home; the patient did not seek medical help. Several gouty tophi were detected in the heart. Histological examination revealed a large array of amorphous inhomogeneous mass in the thickness of the myocardium, which was framed by a fibrosis zone. Muscle fibers were relaxed, wave-like deformed, with moderately loosened swollen myoplasm, dull nuclei. Monourate Na crystals with a perifocal giant cell inflammatory reaction were determined in all the described tophi. Diagnosis: Gout: gouty tophi in the thickness of the myocardium of the interventricular septum, wall of the left ventricle. Generalized embolization of the vessels of the microcirculatory bed with a basophilic substrate. Phlegmonous inflammation of the myocardium. 
Conclusion. In the presented case, gouty tophi were detected in the heart with the development of purulent-necrotic decay and the development of exudative inflammation with generalized embolization of the vessels of the microcirculatory bed with a basophilic substrate. This case is rare and has practical interest, since it developed at a young age with local damage to the heart.