Histopathologic Examination of Conjunctival Tophi in Gouty Arthritis

Lo, Wayne R.; Broocker, Geoffrey; Grossniklaus, Hans E.

doi:10.1016/j.ajo.2005.07.023

Cited by 21 publications

(12 citation statements)

References 3 publications

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“…Several studies have noted associations with inflammatory reactions such as conjunctivitis and anterior uveitis [ 1 – 4 ]. There have also been reports of gouty crystal deposits in the cornea, sclera, and iris [ 5 , 6 ]. A recent study by Lin et al [ 7 ] investigated 380 patients with gout and reported two cases of corneal and one case of scleral uric crystal deposits.…”

Section: Introductionmentioning

confidence: 99%

Retinal complications of gout: a case report and review of the literature

2018

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BackgroundThere have been few reported findings of posterior segment complications of gout. While exudative lesions, an increased risk of macular degeneration, and vascular occlusions have been previously reported, to our knowledge, refractile macular lesions have not been reported in a patient with chronic uncontrolled gout.Case PresentationHighly refractile, crystal-like lesions were found in the macula of a 62 year old male patient with chronically uncontrolled gout. The lesions appeared at the termination of retinal arterioles and were located at the level of the retinal pigment epithelium. The lesions did not stain with fluorescein and were associated with larger areas geographic atrophy. Review of the patient’s blood tests revealed well-controlled vasculopathic risk factors. Fundus appearance and best-corrected visual acuity remained stable over 12 months of follow-up during which the uric acid levels were well controlled.ConclusionRetinopathy may be associated with chronically uncontrolled gout and patients with visual complaints should undergo a dilated examination in addition to the typical anterior segment slit-lamp exam.

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Section: Introductionmentioning

confidence: 99%

Retinal complications of gout: a case report and review of the literature

2018

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“…Thirty-six articles were found in the literature documenting ocular urate deposition as seen by histopathology and clinical exam ( Table 1 ). Urate deposits have been reported in nearly all ocular and adnexal structures including the eyelid [ 55 ], medial and lateral canthus [ 56 , 57 ], conjunctiva [ 58 ], sclera [ 59 ], cornea [ 60 ], lens, iris [ 61 ], orbital fossa [ 62 ], and retina [ 63 ]. The eyes may be predisposed to tophi secondary to lower body temperatures and a low pH environment resulting in poor solvent capabilities [ 61 , 64 ].…”

Section: Resultsmentioning

confidence: 99%

Systemic Urate Deposition: An Unrecognized Complication of Gout?

Khanna

Johnson

Marder

et al. 2020

JCM

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Gout, an inflammatory arthritis, affects over nine million people in the US with increasing prevalence. Some medical societies do not recommend treating gout unless it is recurrent. While soft tissue urate deposits (tophi), resultant bone erosions, and joint inflammation are frequently recognized in gout, urate crystal deposits in other sites have been thought to be rare. Recent diagnostic testing, such as dual energy computed tomography (DECT), has led to the recognition that urate deposits are not uncommon in other tissues including the vasculature. To understand the potential risks for untreated gout, we reviewed the literature on extra-articular urate deposition documented by autopsy, histopathology, surgery, and radiology, including the heart, blood vessels, kidney, spine, eye, skin, and gastrointestinal system. These studies extend the significance of gout beyond the rheumatologist and emphasize the need for physicians to follow the American College of Rheumatology guidelines to treat subjects with gout to a goal of achieving serum urate <6 mg/dl. Given the growing body of literature on extraarticular urate deposition, further studies and clinical trials are needed to determine the clinical consequences of systemic urate deposition, including if reducing cardiac and vascular urate deposits may provide a survival benefit for this at-risk population.

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“…24,25 Lipoid proteinosis is a rare, autosomal recessive deposition disorder characterized by eosinophilic hyaline material deposition within the dermis, around blood vessels and adnexal structures, which stains positively for periodic acid-Schiff and negatively for Congo red. However, their differing clinical presentations will aid in distinguishing these entities.…”

Section: Discussionmentioning

confidence: 99%

Nodular Amyloidosis Derived From Keratinocytes

Cornejo¹,

Lagana

Deng³

2015

The American Journal of Dermatopathology

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Primary, localized cutaneous amyloidosis includes macular, lichen, and nodular (tumefactive) types in which the amyloid deposits are limited to the dermis without systemic involvement. The material in lichen and macular amyloidosis is derived from epidermal keratinocytes [keratinocyte-derived amyloid (AK)], whereas that in nodular amyloidosis is derived from immunoglobulin light-chains amyloid (AL). Primary, localized cutaneous nodular amyloidosis (PLCNA) is a form of primary, localized cutaneous amyloidosis that has been associated with a risk of progression to systemic amyloidosis. We report an unusual case of nodular AK-type amyloid deposited in the dermis of the feet. The patient is a 60-year-old woman with asymptomatic verrucoid-like lesions present around the medial and lateral aspects of the bilateral heels for 1-2 years. A biopsy showed massive deposition of eosinophilic amorphous material in the papillary and reticular dermis. The material stained positive for Congo red with apple-green birefringence on polarized light. It was also positive for pan-cytokeratin and negative for kappa and lambda light-chain immunostains. An extensive workup was negative for systemic involvement. Lipid chromatography tandem mass spectrometry confirmed that the deposition was AK-type amyloid. We believe that this is the first case of PLCNA with AK deposition. This entity should be included in the differential diagnosis of PLCNA so that an extensive systemic workup may be avoided.

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Histopathologic Examination of Conjunctival Tophi in Gouty Arthritis

Cited by 21 publications

References 3 publications

Retinal complications of gout: a case report and review of the literature

Retinal complications of gout: a case report and review of the literature

Systemic Urate Deposition: An Unrecognized Complication of Gout?

Nodular Amyloidosis Derived From Keratinocytes

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