A leg ulcer with hard, yellow projections.

Area of Science:

• Rheumatology
• Dermatology
• Pathology

Background:

• Gout is a complex inflammatory condition characterized by hyperuricemia and urate crystal deposition.
• While commonly affecting joints, gout can present with diverse, sometimes atypical, clinical manifestations.
• Cutaneous manifestations of gout, though rare, pose diagnostic and management challenges.

Observation:

• An elderly male presented with a chronic, non-healing ulcer on his left leg, characterized by hard, yellow projections.
• Initial assessments revealed normal serum uric acid levels, complicating the diagnosis.
• Histopathological examination was crucial for identifying the underlying cause.

Findings:

• Histopathology confirmed the presence of a gouty tophus, characterized by focal basophilic acellular material.
• The tophus, a hallmark of advanced gout, was the etiology of the persistent leg ulcer.
• Despite a year of follow-up, the ulcer remained unresolved, underscoring the complexity of managing this presentation.

Implications:

• This case highlights the importance of considering gout in the differential diagnosis of chronic leg ulcers, even with normal uric acid levels.
• Wound care professionals may face challenges in managing ulcerations associated with gouty tophi.
• Increased clinical awareness is needed for the rare cutaneous presentations of gout to ensure timely and accurate diagnosis.