Miliarial gout: a rare presentation of extensive cutaneous tophi

Abstract

Gout is a systemic disorder characterized by hyperuricemia and recurrent arthritis, most involvement of ankles, midfoot joint and first metatarsophalangeal joint, with monosodium urate crystals deposition in synovial fluid and other tissues. We present a case of 53-year-old male, who had several nontender, white-yellow papules and plaques over his elbows, knees and arms with chalk-like substances and crust on inflammatory base wax and wane in the past 2 years. Upon histopathology examination of the skin lesions, it reported as intradermal urate tophi and miliarial gout was diagnosed. This case highlights the importance of considering unusual cutaneous tophi in the differential diagnosis of deposition disorders.

From skin to microscope, case report of a rare manifestation of tophaceous gout: Miliary gout

“…6 Regarding miliary gout, unusual locations of tophi (eg, chest, abdomen, back, arms, forearms, thighs) should draw attention to this entity because they have been associated with it. 8,10,12 Thus, in contrast to the peripheral sites, low distal temperature does not appear to play a major role in the pathophysiology of such cutaneous lesions. Hypotheses regarding the clearance ability of MSU by tissue macrophages have been put forward, but the pathogenesis of this clinical expression remains unknown.…”

“…It is a rare cutaneous manifestation of tophaceous gout since only a few cases have been reported. [7][8][9][10][11][12][13][14] To our knowledge, Shukla et al 7 documented the first case in 2007.…”

Miliarial gout: Clinical case and a brief review

“…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.…”

“…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.…”

Disseminated cutaneous gout: a rare manifestation of a common disease

“…The pathogenesis is poorly understood. In our review of 23 reported cases of extensive extra-articular dermal/subcutaneous tophi (including the present case), [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], the majority of patients were male (87%) and Asian (57%), (Table 1). There was fairly equal representation from Asian countries with high gout prevalence (Taiwan) as well as those with low prevalence (China, South Korea, Philippines, Vietnam), [19].…”