Vol. 11, Issue 4 (2025)

Introduction: Gout is a metabolic disorder caused by hyperuricemia and deposition of monosodium urate (MSU) crystals. While joint inflammation is the hallmark of gout, extra-articular manifestations, such as nerve involvement, are extremely rare. Radial nerve neuritis as a presentation of gout is a unique and underreported phenomenon.

Case Presentation: A 75-year-old male presented with a one-month history of burning and pricking pain in the left forearm and multiple joint swellings over few years. Clinical examination revealed multiple tophaceous nodular swellings over the left forearm, left ankle, and right elbow, with sensory deficits suggestive of radial nerve involvement. Laboratory investigations showed hyperuricemia (serum uric acid: 7.5 mg/dL) and elevated CRP (2.4 mg/dL). Radiological imaging demonstrated periarticular erosions, and histopathology of excised tophi confirmed monosodium urate crystals.

Intervention: The patient underwent surgical excision of tophi from the left ankle and right elbow under regional anesthesia. Medical therapy included febuxostat (40 mg BD) for urate-lowering, analgesics for pain management, and dietary modifications. Postoperative care involved wound management and regular follow-up.

Outcome: The patient showed marked improvement, with complete resolution of radial nerve neuritis symptoms and significant relief from joint pain. Follow-up after two weeks revealed no recurrence of symptoms and improved range of motion in the affected joints.

Conclusion: This case highlights the rare presentation of gout as radial nerve neuritis, emphasizing the importance of recognizing atypical manifestations. Early detection and intervention, can effectively resolve symptoms and prevent long-term complications. This report explains the need for a detailed clinical examination to manage such rare and complex cases.