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.

Nadezhda Magdeeva is a DHA-licensed Internal Medicine Specialist, cardiologist, rheumatologist, longevity specialist, and university professor with nearly 20 years of clinical, academic, and research experience. She holds an MD and PhD and has extensive expertise in internal medicine, cardiovascular disease, rheumatology, intensive cardiology, and preventive and longevity medicine. Throughout her career, she has worked as a consultant in a major regional clinical hospital, including its intensive cardiology, rheumatology, and internal medicine departments. She also served as a Professor at Saratov State Medical University, where she taught Internal Medicine to both Russian and international medical students. Since 2026, she has been practicing as an Internal Medicine and Anti-Age Specialist in Dubai, UAE, and serves as a Medical Course Director at the International Board of Medical Practitioners in the United States. She is the author of more than 60 scientific publications and nine textbooks and monographs, with an h-index of 10. She has delivered over 30 scientific lectures and has participated in international Phase III clinical trials across multiple therapeutic areas. Her professional interests include cardiovascular and rheumatic diseases, complex internal medicine, preventive medicine, and evidence-based longevity strategies.