Atypical cutaneous presentation of chronic tophaceous gout: A case report

Pradhan, Swetalina; Sinha, Ruchi; Sharma, Preeti; Sinha, Upasna

doi:10.4103/idoj.idoj_205_19

Cited by 9 publications

(5 citation statements)

References 6 publications

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“…Disseminated subcutaneous deposition is referred to as gout nodulosis or miliarial gout, an extremely rare manifestation. These are “milia-like” nodules of white-creamy tophi deposited in the skin with underlying erythema, which can easily be mistaken as acne or folliculitis [ 16 , 17 ]. Few case reports discuss that nodulosis can be present without gout as well as an initial presentation of gout and is usually associated with hyperuricemia [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Few case reports discuss that nodulosis can be present without gout as well as an initial presentation of gout and is usually associated with hyperuricemia [ 18 , 19 ]. Although the exact pathogenesis of severe intradermal involvement is unknown, some risk factors include obesity, chronic venous insufficiency, and prolonged use of corticosteroids [ 17 ]. Shukla et al further discuss renal insufficiency, chronic diuretic use, and hypertension as potential risk factors for intradermal tophi [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Rare Presentation of Disseminated Gout Nodulosis and Chronic Inflammatory Arthritis

Sami

Arora

2023

Case Reports in Rheumatology

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Background. Gout is an inflammatory arthritis caused by monosodium urate (MSU) deposition. Acute gout is a dramatic painful swelling of the joint; however, MSU can deposit in other tissues as well, including skin, gastrointestinal tract, and bones over time. Disseminated tophi in the skin are a rare presentation of gout known as gout nodulosis. We present a case of gout nodulosis with subcutaneous diffuse miliary nodules in nonarticular areas with concurrent findings suggestive of chronic inflammatory arthritis. Case Presentation. A 39-year-old patient presented with intermittent painful swelling in multiple joints with prolonged morning stiffness. On exam, synovitis was present in multiple proximal interphalangeal joints, wrists, elbows, and knees. Chronic raised pearly nodular rash and swellings on extensor aspects of arms, legs, and anterior abdomen were noticeable. He had negative rheumatoid factor and anti-CCP antibody, C-reactive protein of 0.23 mg/dL, erythrocyte sedimentation rate of 37 mm/hr, and uric acid of 10.6 mg/dL. Hand X-rays revealed severe periarticular osteopenia and joint space narrowing in several joints. Musculoskeletal ultrasound showed a double contour sign at multiple joints and a tophaceous deposit over the olecranon fossa. The biopsy of the nodular rash was consistent with tophi. He was diagnosed with chronic tophaceous gout with skin nodulosis and possible overlap of seronegative rheumatoid arthritis given his X-ray findings. Conclusion. This case discusses one of the rare presentations of gout with disseminated gouty tophi in the skin to raise clinical awareness. The clinical dilemma of the overlap of gout and rheumatoid arthritis posing a diagnostic challenge for clinicians is also highlighted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rare Presentation of Disseminated Gout Nodulosis and Chronic Inflammatory Arthritis

Sami

Arora

2023

Case Reports in Rheumatology

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“…Miliarial gout is a rare variant of the cutaneous form of gout consisting of milialike papules, first described by Shukla et al in 2007. 2 We reviewed 11 cases of miliarial gout reported in the literature (including the current case), [2][3][4][5][6][7][8][9][10][11] with a mean age of 50 (SD = 15) years old, and male preponderance (82%) (Table 1). Of note, 64% of reported cases had no known history of gout, and miliarial gout could be the first manifestation of tophaceous gout.…”

Section: Discussionmentioning

confidence: 99%

“…We reviewed 11 cases of miliarial gout reported in the literature (including the current case), 2–11 with a mean age of 50 (SD = 15) years old, and male preponderance (82%) (Table 1). Of note, 64% of reported cases had no known history of gout, and miliarial gout could be the first manifestation of tophaceous gout.…”

Section: Discussionmentioning

confidence: 99%

Miliarial gout: Clinical case and a brief review

et al. 2021

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“…Cutaneous deposition of MSU crystals is commonly observed over joints or on the ears. Disseminated cutaneous gout is an uncommon skin manifestation of gout, characterized by widespread dermal or subcutaneous tophi that develop at extra-articular sites [3].…”

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confidence: 99%