Panniculitis and Ulcers in a Young Man

Conejo‐Mir, Julián

doi:10.1001/archderm.134.4.499-c

Cited by 15 publications

(5 citation statements)

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“…A number of other unusual skin features caused by cutaneous deposition of tophaceous material in chronic gout can occur, causing problems in differentiating gout from other skin diseases. A few patients with localized or widespread intradermal tophi distant from articular areas 1,2 or with panniculitis resulting from subcutaneous deposition of urate (gouty panniculitis) [3][4][5][6][7][8] have been reported. More recently, a clinical presentation of cutaneous gout as a widespread eruption of tiny, milia-like, intradermal tophi, termed 'miliarial gout', has been described.…”

Section: Discussionmentioning

confidence: 99%

“…All cases of gouty panniculitis reported to date have in common the involvement of the legs, [3][4][5][6][7][8] suggesting that stasis can be critical. 8 Obesity and long-term treatment with furosemide 3,4 and glucocorticoids can also be considered risk factors for both dermal and hypodermal deposition of urates.…”

Section: Reportmentioning

confidence: 99%

“…Some atypical forms of tophaceous gout have been described, including bullous, fungating and ulcerative gout. Gouty panniculitis has been described in six cases, and usually presents as nodular or plaque lesions on the anterior or posterior legs, which quickly ulcerate, draining serous or opaque fluid‐containing crystals. These lesions can be painful or painless, and can be the presenting feature of gout.…”

Section: Reportmentioning

confidence: 99%

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Unilateral milia-type intradermal tophi associated with underlying urate subcutaneous deposition: an uncommon cutaneous presentation of gout

et al. 2013

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Tophi develop during the most advanced clinical stage of gout, and are usually located on or around the joints. However, unusual skin features caused by intradermal and/or subcutaneous deposition of tophaceous material at locations other than articular regions have been reported. We present the case of a patient with a condition that has been recently termed 'miliarial gout'. which is only the second such case, to our knowledge. A 51-year-old woman, who had a chronic joint disease that had been diagnosed and treated as psoriatic arthritis, presented with multiple asymptomatic, yellowish-white, firm papules (1-3 mm in size) on erythematous areas on the outside of her left leg. On histological examination of a skin biopsy, uric acid crystals were seen in the dermis and subcutis. The patient also had a raised level of serum urate, consistent with a diagnosis of gout. Treatment with allopurinol led to rapid improvement. Intake of corticosteroids and diuretics was a possible triggering factor for the development of cutaneous tophi in this patient.

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Section: Discussionmentioning

confidence: 99%

Section: Reportmentioning

confidence: 99%

Section: Reportmentioning

confidence: 99%

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Unilateral milia-type intradermal tophi associated with underlying urate subcutaneous deposition: an uncommon cutaneous presentation of gout

et al. 2013

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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%

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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“…To date, only eight cases, presenting as a crystalline lobular panniculitis, have been found in the databases MEDLINE, EMBASE, BIOSIS, Science citation index and in German Medical Science (Table 1). [1][2][3][4][5][6][7][8] In these reported patients, time to diagnosis was an average of 3.3 years (range 9 weeks to 12 years), which implies a chronic progressive disease course and difficult diagnosis. In six of the reported patients, urate levels were elevated.…”

Section: Discussionmentioning

confidence: 99%