Gouty panniculitis in a 68‐year‐old man: case report and review of the literature

Weberschock, Tobias; Gholam, Patrick; Hartschuh, Wolfgang; Hartmann, Martin

doi:10.1111/j.1365-4632.2010.04283.x

Cited by 18 publications

(28 citation statements)

References 8 publications

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“…In contrast to tophi, panniculitis has been reported, thus far, only in a very small percentage of patients with gout. Thus, Webershock [2] reported one case in 2010 and reviewed 8 prior reported cases from 1977 to 2007 [2, 6–9]. Recently, however, Ochoa et al [1] reported an additional 6 cases from a single institution and concluded that panniculitis should be considered as one of the principal clinical manifestations of gout.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, preexisting subcutaneous tissue damage is known to increase the risk of subcutaneous panniculitis. Additional factors may include venous stasis, varicosities, or chronic edema related to cardiac failure and elevated serum amylase or lipase [2, 7]. Elevated serum amylase and lipase, in patients with renal failure and end stage renal disease, may be due to decreased renal clearance of these enzymes [10, 11].…”

Section: Discussionmentioning

confidence: 99%

“…It is characterized clinically by indurated, erythematous, or ulcerated subcutaneous nodules. Histologic confirmation is achieved by identification of tophaceous crystal deposition in the lobular subcutaneous tissue [1, 2]. The clinical presence of indurated subcutaneous plaques may precede, or appear subsequently to the articular clinical expression of tophaceous gout [1].…”

Section: Introductionmentioning

confidence: 99%

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Gouty Panniculitis with Ulcerations in a Patient with Multiple Organ Dysfunctions

Wang

Rose

Mellen

et al. 2014

Case Reports in Rheumatology

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Gouty panniculitis is a rare manifestation of gout. Clinically, it is characterized by indurated subcutaneous nodules in nonjoint areas. Pathologically, typical characteristic gouty tophi can be seen in subcutaneous tissue. It is postulated that gouty panniculitis develops as a consequence of uric acid accumulation in the body and localized inflammatory changes in subcutaneous tissue. We report a case of a 46-year-old man with 20-year history of gout, who developed multiple subcutaneous nodules over the abdomen and right groin/thigh area over a 2-year period. After a recent episode of congestive heart failure and acute renal failure, the nodules increased in size and the overlying skin became erythematous and ulcerated. Pathologic examination demonstrated typical tophi in the dermis and subcutaneous tissue. A review of the literature yielded fifteen similar cases that had been previously reported. We conclude that gouty panniculitis may be a manifestation of undertreated gout and may be exacerbated by the deterioration of other systemic functions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gouty Panniculitis with Ulcerations in a Patient with Multiple Organ Dysfunctions

Wang

Rose

Mellen

et al. 2014

Case Reports in Rheumatology

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“…Gouty parmiculitis was first described in 1977 by Niemi (2), and only 15 cases have been reported since (2)(3)(4)(5)(6)(7)(8). The lower extremities are common presenting sites, but it can occur anywhere.…”

Section: Discussionmentioning

confidence: 99%

“…Foreign body panniculitis shows granulomatous inflammation with deposition of hyaluronic acid or amyloid (7). Tumoural calcinosis has deposits of amorphous basophilic materials with surrounding foreign body giant cell reaction, and shows positivity for von Kossa stain and no birefringence (11).…”

Section: Discussionmentioning

confidence: 99%

Gouty Panniculitis also Involving the Bone Marrow

Choi¹,

Lew²,

Lee³

et al. 2013

Acta Derm Venerol

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Gout is a clinical syndrome presenting with recurrent, painful arthritis caused by deposition of monosodium urate. Urate crystal deposits are usually detected in the synovial membranes, joint capsules, articular cartilage, and periarticular tissue, and, rarely, in extra-articular areas (1). Gouty patiniculitis is characterized by subcutaneous depositions of urate crystals with lobular panniculitis. We report here a case of this rare variant of gout, in a 47-year-old man who also showed characteristic depositions of crystals in the bone marrow. CASE REPORTA 47-year-old man presented with skin-coloured to brownish subcutaneous nodules and plaques on both extremities, both hands, and the joints of the foot for 3^ years. He complained of pain, but denied pruritus or any other symptoms. He had had hypertension and had been treated with isosorbide-5-mononitrate 50 mg, daily for 10 years. In addition, he had undergone haemodialysis for end-stage renal disease for 8 years. He also underwent amputation of all of his toes due to thromboangitis obliterans 2 years previously. He had recently been diagnosed with hypothyroidism and took 100 \ig per day levothyroxine sodium (Synthyroxine®, Darim, Seoul, Korea). On physical examination, multiple, various sized, oval-to-linear, firm, fixed, subcutaneous papules, nodules, and plaques were found (Fig. 1). In addition, his skin showed a sclerotic appearance and his joints were not fully extendable. His red blood cell count was 2.32 X lO'/l and white blood cell count was 2.3 x lOVl, with 74.3% neutrophil segments, mild anaemia and neutropaenia. Blood urea nitrogen and uric acid levels were within normal limits (23 mg/dl and 4.2 mg/dl, respectively, upper normal limit 24 and 4.5 mg/dl, respectively). However, creatinine level was markedly elevated (4.6 mg/dl) and levels of iron and total iron-binding capacity were decreased (38 ng/dl and 95 |ig/dl, respectively). Other haematological and autoimmue markers, including antinuclear antibody, rheumatic factor, antimicrosomal antibody, and extractable nuclear antigen profiles, were not remarkable. A biopsy specimen showed that fine, needle-shaped. Fig.

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Panniculitis

Requena

2016

Rook's Textbook of Dermatology, Ninth Edition

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The panniculitides comprise a group of heterogeneous inflammatory diseases that involve the subcutaneous fat. Histopathological study is required for the specific diagnosis of these disorders, because different panniculitides usually show the same clinical appearance – which typically consists of erythematous nodules on the lower extremities. However, the histopathological study of panniculitis is difficult because of the poor correlation between clinical and pathological findings and the changing microscopic appearances as the lesions evolve. Furthermore, large scalpel incisional biopsies are required in order to evaluate panniculitis fully. From the histopathological point of view, all panniculitides are somewhat mixed, because the inflammatory infiltrate involves both the septa and lobules. However, differentiation between a predominantly septal and a predominantly lobular panniculitis is usually straightforward at scanning magnification on the basis of which subcutaneous structures are the more intensely involved by the inflammatory infiltrate.

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Gouty panniculitis in a 68‐year‐old man: case report and review of the literature

Cited by 18 publications

References 8 publications

Gouty Panniculitis with Ulcerations in a Patient with Multiple Organ Dysfunctions

Gouty Panniculitis with Ulcerations in a Patient with Multiple Organ Dysfunctions

Gouty Panniculitis also Involving the Bone Marrow

Panniculitis

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