Gout is a prevalent inflammatory metabolic disease induced by the deposition of monosodium urate crystals in joints and soft tissues. Worldwide, gout is the commonest of the inflammatory arthritides, with over nine million new cases reported in 2019. In Europe, between 1 and 4 per cent of the general population are affected. Risk factors for the development of gout include: Male sex, purine-rich diet, family history, diuretic use, hypertension, cardiovascular disease, cerebrovascular disease, type 2 diabetes mellitus, obesity, psoriasis, sickle cell disease, anaemia, and chronic kidney disease (CKD). Gout has been implicated in the development of cardiovascular disease and the deterioration of co-existing CKD.

Gout and asymptomatic hyperuricemia significantly increase cardiovascular risk. This is why serum uric acid testing is included in the standard cardiac examination. However, in addition to the high cardiovascular risk, severe gout can lead to the deposition of tophi in virtually all tissues and organs, including heart valves, necessitating differential diagnosis with infective endocarditis, especially in the presence of signs of sepsis. This presentation presents a clinical case of a young patient with severe, untreated gout, with multiple subcutaneous tophi that periodically ruptured.

In the autumn of 2025, he noted a deterioration in his condition, characterized by an exacerbation of his joint syndrome and spontaneous rupture of a tophus in his buttock, leading to the formation of a subcutaneous fistula. Sepsis developed due to the presence of a portal of entry for infection. An echocardiogram was performed, revealing a mass in the mitral valve leaflets. A differential diagnosis with infective endocarditis was conducted. Despite comprehensive active therapy, an unfavorable outcome ensued. An autopsy confirmed the premortem diagnosis of tophi deposition in the mitral valve leaflets.

Conclusion: All patients with gout and hyperuricemia have an increased risk of cardiovascular complications. In severe tophaceous gout, any organ or system, even the heart valves, can be affected. A comprehensive, interdisciplinary approach to treating this patient population is essential.

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