Weak and Numb Feet in a Man With Knobby Hands

A 91-year-old man with a 40-year history of progressively disfiguring tophaceous gout, hypothyroidism, and remote alcohol abuse presented to the hospital with a 4-month history of progressive weakness and numbness of the lower extremities (Figure 1 and Figure 2). Examination revealed a cheerful, elderly man with severe tophaceous gout affecting the proximal metacarpophalangeal and interphalangeal joints. He was clinically euthyroid.