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The Presence of Biofilms in Gouty Tophi

In patients who had confirmed gout, we have pathologically identified biofilms in cutaneous tophi. 
Clinically, these lesions were asymptomatic, off-white papules on the ears and/or extremities. The methods 
used for confirmation were the same as those used for biofilms in other organs, namely staining for the 
extracellular polysaccharides which make up the bulk of the biofilm with colloidal iron (CFE), and Congo 
red (CR) that stains the amyloid that serves as infrastructure of the biomass. CFE was used, instead of 
periodic acid Schiff (PAS), because of the presence of uric acid crystals in the tophi; CFE, which stains 
acidic mucin, was used and showed more positivity than PAS that stains neutral mucins. These stains were 
positive in the areas of the tophus and negative in the surrounding tissue. CD 282 (Toll-like receptor 2) 
immunostain was negative in all, save for faint staining in one specimen, indicating the immune system was 
not involved.