Acrosteolisis severa en artritis gotosa y síndrome de Down

the association between gout and down syndrome (ds) is very infrequent, in spite that both diseases are common in general population. surprisingly, hyperuricemia is a common metabolic impairment in ds. in this report we describe a 35-years old man with ds presenting with arthritis in the fifth and then in the first toe of his left foot. severe osteolysis of the first and fifth toe was seen by radiography. because of this, neoplasm was suspected but later ruled out by oncologic orthopedist. after we found hyperuricemia a diagnosis of gout was made, and then confirmed by examination of a sample obtained from a subcutaneous node. this report is one of the few cases previously published. in addition, development of gout in this patient has unusual features like its onset in the fifth toe and its severity at presentation. in spite that hyperuricemia is common in ds, in not clear why these patients mostly do not develop gout.