Panniculitis of the legs with urate crystal deposition

Abstract

Dark red nodules that drained an opaque amber liquid developed on the extensor surfaces of both legs in a 69-year-old woman receiving furosemide and spironolactone for congestive heart failure. In addition to asymptomatic cholelithiasis, the serum amylase, lipase, and uric acid levels were elevated. Other skin signs and joint manifestations of gout were absent. A biopsy revealed a granuloma with the needle-like crystals characteristic of gout.

Gouty Panniculitis with Ulcerations in a Patient with Multiple Organ Dysfunctions

“…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.…”

“…Some patients, who have a normal uric acid level at diagnosis, may have experienced long-term hyperuricemia at an earlier time. Among all 18 cases, abnormal renal function was noted in 12 (66.7%) patients [1, 6, 8, 9, 17, 18]. Due to the lack of complete metabolic panel (CMP) data, renal function in the remaining 6 cases could not be assessed [2, 7, 19].…”

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

“…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.…”

Gouty Panniculitis also Involving the Bone Marrow

“…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.…”