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Diagnosing an ulcerated gouty tophus
Allie Preston1, Bradley Evanson2, Katherine Fiala2
1College of Medicine, Texas A&M Health Science CenterTempleTexas.
Proceedings (Baylor University. Medical Center)
|April 9, 2019
Summary
A man with gout developed unusual skin ulcers. These ulcers drained sodium urate crystals, confirming a gout complication, not infection.
Area of Science:
- Rheumatology
- Dermatology
- Crystal-induced Arthropathies
Background:
- Gout is a common inflammatory arthritis caused by monosodium urate crystal deposition.
- Complicated medical histories can present diagnostic challenges.
Observation:
- A 44-year-old male presented with symptoms suggestive of sepsis and severe joint pain, initially attributed to pneumonia and gout.
- Despite negative infectious workups, the patient developed ulcerated, draining wounds on extremities.
- A chalky exudate from the wounds was microscopically analyzed.
Findings:
- Polarized microscopy revealed sodium urate crystals with negative birefringence in wound exudate.
- The patient's symptoms improved with corticosteroid treatment and management of hyperuricemia.
Implications:
- This case highlights a rare but significant manifestation of severe gout, presenting as cutaneous ulcerations.
- Differentiating crystal-induced lesions from infectious etiologies is crucial for appropriate patient management.
- Effective management involves addressing hyperuricemia and inflammation to prevent or treat such complications.
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