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Eruptive xanthomata with urate-like crystals

N M Walsh1, S Murray, Y D'Intino

  • 1Department of Pathology, Victoria General Hospital, Nova Scotia, Canada.

Journal of Cutaneous Pathology
|August 1, 1994
PubMed
Summary

Eruptive xanthomata can mimic granuloma annulare. A rare variant shows needle-shaped crystals, initially misdiagnosed as gout, highlighting the need for clinicopathologic correlation in diagnosing these skin lesions.

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Area of Science:

  • Dermatopathology
  • Histopathology
  • Crystal Arthropathies

Background:

  • Eruptive xanthomata typically present as foamy macrophage aggregates in the dermis.
  • Microscopic examination can reveal variability, sometimes mimicking granuloma annulare.
  • Hypertriglyceridemia is a common underlying condition associated with eruptive xanthomata.

Observation:

  • A novel histopathological variant of eruptive xanthomata was identified in skin biopsies from two patients with hypertriglyceridemia.
  • These lesions exhibited a granuloma annulare-like pattern under low magnification.
  • A key feature was the presence of polarizable, needle-shaped crystals within the lesions.

Findings:

  • The observed crystals showed characteristics similar to monosodium urate monohydrate.
  • Polarized light microscopy revealed negative birefringence of these crystals.
  • Initial pathological diagnoses of gout were made due to the crystal morphology, necessitating further clinicopathologic correlation.

Implications:

  • Recognition of this unusual microscopic variant of eruptive xanthomata is crucial for accurate diagnosis.
  • This finding may help reduce diagnostic errors, particularly differentiating from crystalline arthropathies like gout.
  • Further investigation into the chemical composition of these unique crystals is warranted.

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