A patient with arthritis, severe back pain, impaired wound healing, and perforated sigmoid colon

Because repeated blood cultures were negative, we concluded that high systemic concentrations of inflammatory markers and fever were caused by diffuse urate crystal deposition and not by presumptive bacterial infection. However, because high therapeutic costs are a consideration with this drug,1 pegylated urate oxidase formulations2 or febuxostat, a novel selective non-purine xanthine oxidase inhibitor,3 might be possible therapeutic options for continuous treatment of severe cases of tophaceous gout in the future.