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Disseminated gouty panniculitis: an unusual presentation of extensive cutaneous tophi.

Pattanaprichakul P, Bunyaratavej S, McLain PM, Varothai S - Dermatol Pract Concept (2014)

Bottom Line: Gouty panniculitis is a rare cutaneous illness characterized by the deposition of subcutaneous mono-sodium urate crystals with lobular panniculitis.Only a small number of cases with gouty panniculitis have been reported in the literature with unclear pathogenesis.In this article, we present a case of disseminated gouty panniculitis in the patient who had never been diagnosed of gout but revealed significant hyperuricemia at the time of diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

ABSTRACT
Gouty panniculitis is a rare cutaneous illness characterized by the deposition of subcutaneous mono-sodium urate crystals with lobular panniculitis. Only a small number of cases with gouty panniculitis have been reported in the literature with unclear pathogenesis. In this article, we present a case of disseminated gouty panniculitis in the patient who had never been diagnosed of gout but revealed significant hyperuricemia at the time of diagnosis.

No MeSH data available.


Related in: MedlinePlus

(A) Lobular panniculitis with amorphous material in deep dermis and subcutis (H&E, x40). (B–D) Foreign-body granulomatous inflammation surrounding crystalline deposits [H&E; (B) x100, (C) x200, and (D) x400]. (Copyright: ©2014 Pattanaprichakul et al.)
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f2-dp0404a05: (A) Lobular panniculitis with amorphous material in deep dermis and subcutis (H&E, x40). (B–D) Foreign-body granulomatous inflammation surrounding crystalline deposits [H&E; (B) x100, (C) x200, and (D) x400]. (Copyright: ©2014 Pattanaprichakul et al.)

Mentions: A 40-year-old man presented with a 2-year history of widespread nontender, firm, and white to yellow nodules and plaques over the trunk, arms, legs, and dorsum of both feet. The patient reported intermittent arthralgia and occasional swelling of both ankles over the past 4 years. The patient denied other concomitant medical conditions, including gouty arthritis or history of alcohol abuse. He reported a negative familial history of gout or renal diseases. Physical examination revealed a body mass index (BMI) of 34 and blood pressure of 140/80 mmHg. Other systemic evaluation was unremarkable except for the presence of nodules and plaques with some ulceration covered with a chalk-like substance over all extremities, trunk, and dorsal feet (Figure 1). Clinical signs of arthritis and arthralgia were not appreciated at the time of examination. Upon further investigation, the patient’s serum uric acid was elevated to 12.2 mg/dL (normal range 3.6–7.7 mg/dL). Complete metabolic panel and complete blood cell count were within normal range except for the X-rays of the hands and feet which showed some osteophytes without significant bony destruction. A skin biopsy demonstrated basophilic, amorphous material surrounded by foreign body granulomas, located in the deep dermis and subcutaneous fat lobules with focal lymphohistiocytic infiltrate (Figure 2A–D). These deposits were negatively birefringent under polarized microscopy. Periodic acid-Schiff (PAS) and acid fast bacilli (AFB) stain were negative for microorganisms. Given the clinical and laboratory findings, the diagnosis of disseminated gouty panniculitis was made.


Disseminated gouty panniculitis: an unusual presentation of extensive cutaneous tophi.

Pattanaprichakul P, Bunyaratavej S, McLain PM, Varothai S - Dermatol Pract Concept (2014)

(A) Lobular panniculitis with amorphous material in deep dermis and subcutis (H&E, x40). (B–D) Foreign-body granulomatous inflammation surrounding crystalline deposits [H&E; (B) x100, (C) x200, and (D) x400]. (Copyright: ©2014 Pattanaprichakul et al.)
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4230255&req=5

f2-dp0404a05: (A) Lobular panniculitis with amorphous material in deep dermis and subcutis (H&E, x40). (B–D) Foreign-body granulomatous inflammation surrounding crystalline deposits [H&E; (B) x100, (C) x200, and (D) x400]. (Copyright: ©2014 Pattanaprichakul et al.)
Mentions: A 40-year-old man presented with a 2-year history of widespread nontender, firm, and white to yellow nodules and plaques over the trunk, arms, legs, and dorsum of both feet. The patient reported intermittent arthralgia and occasional swelling of both ankles over the past 4 years. The patient denied other concomitant medical conditions, including gouty arthritis or history of alcohol abuse. He reported a negative familial history of gout or renal diseases. Physical examination revealed a body mass index (BMI) of 34 and blood pressure of 140/80 mmHg. Other systemic evaluation was unremarkable except for the presence of nodules and plaques with some ulceration covered with a chalk-like substance over all extremities, trunk, and dorsal feet (Figure 1). Clinical signs of arthritis and arthralgia were not appreciated at the time of examination. Upon further investigation, the patient’s serum uric acid was elevated to 12.2 mg/dL (normal range 3.6–7.7 mg/dL). Complete metabolic panel and complete blood cell count were within normal range except for the X-rays of the hands and feet which showed some osteophytes without significant bony destruction. A skin biopsy demonstrated basophilic, amorphous material surrounded by foreign body granulomas, located in the deep dermis and subcutaneous fat lobules with focal lymphohistiocytic infiltrate (Figure 2A–D). These deposits were negatively birefringent under polarized microscopy. Periodic acid-Schiff (PAS) and acid fast bacilli (AFB) stain were negative for microorganisms. Given the clinical and laboratory findings, the diagnosis of disseminated gouty panniculitis was made.

Bottom Line: Gouty panniculitis is a rare cutaneous illness characterized by the deposition of subcutaneous mono-sodium urate crystals with lobular panniculitis.Only a small number of cases with gouty panniculitis have been reported in the literature with unclear pathogenesis.In this article, we present a case of disseminated gouty panniculitis in the patient who had never been diagnosed of gout but revealed significant hyperuricemia at the time of diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

ABSTRACT
Gouty panniculitis is a rare cutaneous illness characterized by the deposition of subcutaneous mono-sodium urate crystals with lobular panniculitis. Only a small number of cases with gouty panniculitis have been reported in the literature with unclear pathogenesis. In this article, we present a case of disseminated gouty panniculitis in the patient who had never been diagnosed of gout but revealed significant hyperuricemia at the time of diagnosis.

No MeSH data available.


Related in: MedlinePlus