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Updated: Jul 19, 2026
12:23
Granulocyte-dependent Autoantibody-induced Skin Blistering
Published on: October 12, 2012
Blister as the initial presentation of gout
Keith T Rott1, N Wilson Holland, Carlos A Agudelo
1Division of Rheumatology and Immunology, Emory University School of Medicine, Atlanta, USA.
Summary
Gout can manifest as a bullous lesion, even in patients without a prior diagnosis. Microscopic examination of blister fluid is crucial for diagnosing gout by identifying monosodium urate crystals.
Area of Science:
- Rheumatology
- Dermatology
Background:
- Gout is a common inflammatory arthritis characterized by hyperuricemia and deposition of monosodium urate crystals.
- Bullous lesions are an uncommon presentation of gout, with limited literature available.
Purpose of the Study:
- To report a case of gout presenting as a bullous lesion.
- To highlight the diagnostic importance of blister fluid aspiration and crystal analysis in gout.
Main Methods:
- Clinical presentation of a patient with an unusual bullous lesion was documented.
- Aspiration of the bullous fluid was performed.
- Microscopic examination of the aspirated fluid for monosodium urate crystals was conducted.
Main Results:
- A large blister was observed over the first metatarsophalangeal joint.
- Microscopic analysis of the blister fluid revealed numerous monosodium urate crystals.
- The patient had no prior history of gout, and the lesion was initially misdiagnosed as a pressure sore.
Conclusions:
- Bullous lesions can be an initial presentation of gout, potentially leading to diagnosis in undiagnosed patients.
- Gouty blisters may arise from trauma, similar to gouty tophi.
- Thorough clinical evaluation and microscopic examination of aspirated fluids are essential for accurate gout diagnosis.
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