Disseminated gouty panniculitis: an unusual presentation of extensive cutaneous tophi

Abstract

Gouty panniculitis is a rare cutaneous illness characterized by the deposition of subcutaneous mono-sodium urate crystals with lobular panniculitis. Only a small number of cases with gouty panniculitis have been reported in the literature with unclear pathogenesis. In this article, we present a case of disseminated gouty panniculitis in the patient who had never been diagnosed of gout but revealed significant hyperuricemia at the time of diagnosis.

Systemic Urate Deposition: An Unrecognized Complication of Gout?

“…Miliarial gout, gouty panniculitis and gout nodulosis are terms used to describe the cutaneous manifestations of intradermal MSU deposits. It is hypothesized that uric acid may deposit in regions of previous tissue damage [ 78 ]. There were 48 articles documenting urate deposition in the integumentary system demonstrated by autopsy, histopathology, and clinical exam ( Table 1 ).…”

“…Dilated blood vessels within the dermis as well as wall thickening of the small and larger dermal vessels have been reported under light microscopy [ 80 ]. Gouty panniculitis is secondary to MSU deposits in the lobular hypodermis [ 81 ], and in these cases, histopathology revealed urate crystals with adjacent fat lobular inflammation secondary to lymphocytic infiltration [ 78 ]. In many of the reported cases, ULT resolved existing skin lesions and may have prevented new lesion formation [ 78 , 82 ].…”

“…Pract. Concept 2014;4(4):33–35, distributed in accordance with a Creative Commons Attribution license, [ 78 ].…”

Effects of hyperuricemia on the skin

“…zastój żylny, żylaki, przewlekły obrzęk związany z niewydolnością serca oraz wzrost aktywności amylazy lub lipazy w surowicy [40,43].…”

“…Niektóre doniesienia opisują poprawę zmian skórnych po leczeniu hiperurykemii dużymi dawkami allopurynolu 600-1200 mg/dobę w połączeniu z kolchicyną [41,43].…”