Diagnostic dilemmas in unusual presentations of gout.

Background: Gout is known to mimic conditions as diverse as joint and soft tissue infections, skin malignancies, nerve compression syndromes and soft tissue tumours. Upper limb involvement is unusual.

Objective: We discuss four cases of gout in the hand and wrist masquerading as a soft tissue tumour, nodular extensor tenosynovitis, septic arthritis of the wrist and acute and chronic median nerve compression. These cases illustrate that gout in the hand and wrist can resemble more sinister conditions, often posing a diagnostic challenge even to the experienced clinician.

Discussion: In the management of hand and wrist pain, swelling and neuropathy, emphasis must be placed on actively excluding limb and life threatening conditions such as septic arthritis and neoplasia. Laboratory and radiological investigations cannot accurately distinguish these pathologies from gout. Invasive surgical exploration or tissue sampling is often needed to establish the correct diagnosis.