Multiple Cutaneous Creamy Papules and Nodules: A Case of Miliarial Gout

Abstract

Miliarial gout is a rare form of cutaneous tophaceous gout that is treated using xanthine oxidase inhibitors such as allopurinol and febuxostat or uricosurics such as probenecid.

Disseminated cutaneous gout: a rare manifestation of a common disease

“…In some instances, the term miliarial gout has been used to describe cases featuring diffuse milialike papules [3]. Given its varied clinical morphologies, the differential diagnosis can also include calcinosis cutis, rheumatoid nodules, foreign body granulomas, and eruptive xanthomas [4]. The pathogenesis is poorly understood.…”

“…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].…”

Multiple asymptomatic juxta-articular nodules mimicking tuberous-xanthoma–a unusual presentation of tophaceous gout

“…Tophaceous gout can present with varied cutaneous manifestations including papular, nodular, ulcerative, and pustular forms. [ 2 ] The nodules can be firm, smooth or multilobulated and are situated in the subcutaneous plane. [ 3 ] The 3 different stages of gout, which may be seen after years of asymptomatic hyperuricemia, are acute gouty arthritis; intercritical gout, which includes the intervals between attacks; and chronic tophaceous gout.…”

“…Acute inflammatory attacks are managed with colchicine and non-steroidal anti-inflammatory drugs. [ 2 ]…”

“…[ 10 ] In our case, apart from the above diagnosis, gouty tophus was considered and the biopsy revealed the characteristic foreign body inflammation surrounding aggregates of eosinophilic feathery material. [ 2 ] This in conjunction with the raised uric acid and the X-ray findings was in favor of a diagnosis of tophaceous gout [ Table 1 ].…”