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Instead, unnecessary tests were performed, increasing costs without aiding diagnosis. This case highlights the need to use simple, available diagnostic tests in resource-limited settings before relying on costly investigations that can impose a heavy financial burden on patients. Likewise, it emphasises recognising atypical presentations of gouty tophi, such as isolated soft tissue involvement without joint involvement.<\/jats:p>","DOI":"10.1136\/bcr-2024-263343","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T23:45:25Z","timestamp":1737503125000},"page":"e263343","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Atypical presentation of gouty tophi in a resource-limited setting"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2460-4282","authenticated-orcid":false,"given":"Issakwisa Habakkuk","family":"Mwakyula","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Mbeya Zonal Referral Hospital, Mbeya, United Republic of Tanzania"},{"name":"Department of Internal Medicine, University of Dar es Salaam Mbeya College of Health and Allied Sciences, Mbeya, United Republic of Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5545-0255","authenticated-orcid":false,"given":"Gloria Reginald","family":"Mbwile","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Child Health, University of Dar es Salaam Mbeya College of Health and Allied Sciences, Mbeya, United Republic of Tanzania"},{"name":"Department of Pediatric and Child Health, Mbeya Zonal Referral Hospital, Mbeya, United Republic of Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7687-3017","authenticated-orcid":false,"given":"Liset M","family":"Torres","sequence":"additional","affiliation":[{"name":"Department of Pathology, Mbeya Zonal Referral Hospital, Mbeya, United Republic of Tanzania"},{"name":"Department of Pathology, University of Dar es Salaam Mbeya College of Health and Allied Sciences, Mbeya, United Republic of Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2292-7114","authenticated-orcid":false,"given":"Baraka Michael","family":"Chaula","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Dermatology Unit, Mbeya Zonal Referral Hospital, Mbeya, United Republic of Tanzania"},{"name":"Department of Internal Medicine, Dermatology Unit, University of Dar es Salaam Mbeya College of Health and Allied Sciences, Mbeya, United Republic of Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,21]]},"reference":[{"key":"2025082707103980000_18.1.e263343.1","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1002\/acr.21772","article-title":"2012 American College of Rheumatology guidelines for management of gout. 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