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Widespread arterial calcification in a patient with gout.

A 44-year-old man was referred to our department because of recurrent arthritis attacks lasting for 15 years. He had been taking methyl-prednisolone (4-16 mg/day) for 15 years according to his symptoms. He had tophi like nodules on dorsal surfaces of his hands, lateral surfaces of feet and on his right earlobe. Arterial pulses were not palpable in both upper and lower extremities. Widespread arterial calcifications were detected on radiological assessment of four extremities and pelvic region. Uric acid crystals were seen on polarized light microscope in specimen obtained from tophus like nodule. Serum and urinary uric acid levels were 10.3 mg/dl and 200 mg/day, respectively. Serum glucose, creatinine, calcium, phosphorus and parathyroid hormone levels were normal. His total cholesterol and LDL cholesterol levels were 198 mg/dl and 123 mg/dl, respectively. Considering that glucocorticoids may give rise to tophus formation (1) and arterial calcification (2), uncontrolled glucocorticoid usage may have played a role in widespread arterial calcification and tophi formation in this case.