Carpal tunnel syndrome caused by gout is rare. We describe a case of entrapment of the median nerve secondary to intratendinous infiltration by gouty tophi in a 54-year-old man. The tophus was excised from the profundus tendon but the superficialis was too infiltrated and destroyed to be saved. The patient made an uneventful recovery with relief of his symptoms. This case illustrates the potential consequences this could have for hand function.

Following reports of hemorrhage from renal microaneurysms caused by renal biopsy, renal arteriography has been used increasingly as a screening procedure prior to renal biopsy as well as for diagnostic investigation. The incidence of renal microaneurysms has been documented in a group of 40 cases of suspected polyarteritis nodosa, of whom 15 were confirmed, and only 2 had microaneurysms. Both subjects with microaneurysms had more florid clinical disease. In view of the low incidence of microaneurysms it is suggested that renal angiography should be used as a diagnostic investigation only in cases with florid clinical disease and not as a screening procedure prior to renal biopsy.

Summary An unusual case of hypereosinophilic syndrome is described which presented with peripheral neuropathy with no evidence of cardiac involvement. The response to steroid therapy is documented and the literature on peripheral neuropathy in hypereosinophilic syndrome is reviewed.

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