An unusual clinical presentation of granulomatous tophaceous gout in the wrist

The possibility of infection with mycobacterium tuberculosis (TB), and other infectious agents is the first option when granulomatous inflammation wasobserved in the histological examination of a tissue specimen. However, gout with manifestations of granulomatous synovitis may mimic TB tenosynovitis. An 80-year-old male with a history of hypertension, and gout presented with the swelling of the right wrist, and deformity as a result of trauma. The results of cytology for malignancy, TB polymerase chain reaction (PCR), and TB culture were negative. Histopathological examination with an electron microscope confirmed the diagnosis of tophaceous gout along with granulomatous synovitis. The current case emphasizes the significance of a correct gouty process diagnosis in patients who exhibit granulomatous tophaceous tuberculous tenosynovitis or rheumatoid arthritis. We suggested that gout should be considered in differential diagnosis of granulomatous synovitis, especially in cases with negative mycobacterium TB-PCR.