Transcript Document

SEVERE DISSEMINATED CUTANEOUS GOUT
-CASE REPORTIrina Tudose1, Olguta Anca Orzan2, Diana Petrache2, Prof. Dr. Calin Giurcaneanu2
1 Pathology Department, Elias University Emergency Hospital, Bucharest
2 Dermatology Department, Elias University Emergency Hospital, Bucharest
We present the case of a 53-year-old obese caucasian male
with a history of severe hyperuricemia and acute gouty arthritis;
frequent hunter and consumer of venison
Chief complaints: disseminated yellow skin nodules dating for about
five years with an accelerated development of the lesions during the
last year.
Histopathological examination (2010): chronic granulomatous
inflammatory process, endogenous foreign body, most likely dermal
calcinosis
Past medical history (PMH):
Gouty arthritis (1996) – inconsistently treated
Focal segmental glomerulosclerosis (renal biopsy, 2003)
Chronic renal failure
Moderate chronic anemia
Essential hypertension (2004)
Medication: Verapamil, Furosemide
Family history (FH): not significant.
 Grade III obesity (BMI
= 43 kg/m2)
 Joint swelling (right
knee joint and bilateral
hand interphalangeal
joints)
 No lung rales, BP =
130/80 mm Hg, AV =
80/min
 no bowel obstruction,
occasionally
rectorhagia
 inflammatory syndrome
(ESR = 96 mm/h, Fb =
475 mg/dl)
 anemia (Hb = 10 g/dl, Ht
= 32.2%)
 nitrogen retention
(creatinine = 1.83 mg/dl)
 uric acid = 11.45 mg/dl
 mild hyperkalemia
 proteinuria (1.2 g/24 h)
Clinical examination
Multiple disseminated nodules, 1-15 mm diameter,
some of them ulcerated and draining a white chalky
material
Histopathological examination
Usual and special stains:
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Haematoxilin-eosin
Periodic acid Schiff (PAS)
Gömöri stain – for reticulin fibers
Von Kossa stain – for calcium deposits
Red of Congo – for amiloid
Elastic Von Gieson – for elastic fibers
Polarized light examination
Histopathological description: Two pieces of skin showing
dermal granulomatous chronic inflammation with numerous
multinucleated giant cells of "foreign body" and foamy
macrophages located around focal areas of extensive deposition
of amorphous material, acellular, pale-basophilic with focal
areas of central suppurative necrosis. After using special stains,
it was established that histopathological appearance is
compatible with the diagnosis of gout.
Large areas of amorphous
acellular, pale-basophilic
material deposition
surrounded by chronic
granulomatous
inflammation
HEx40
HEx40
HEx200
vGx200
Van Gieson stain – for elastic fiber,
preserved in the periphery areas of
amorphous material deposition
Von K x200
Von Kossa Stain - for the evidence of
calcium salts, absent in this case
Gx400
Gömöri stain – for reticulin fibers
RCx400
Red of Congo – for amiloid,
absent in this case
Differential diagnosis
Rheumatoid
nodules:
areas of fibrinoid
necrosis board
of chronic
granulomatous
inflammation
Von Kossa
Calcinosis cutis universalis:
deposits of calcium phosphate crystals
in the tissues
PAS
Polarized light
examination:
A few monosodium
urate crystals were
found because of the
formalin 10%
preservation of the sent
specimens
Particularities of the case

Rare disease
Davis L. Disseminated cutaneous gout: A rapid onset of disease. J Am
Acad Dermatol 2011; 64 (2 Supp 1); AB113;
 Severity form (uric acid: 7.87 mg/dl → 16.1 mg/dl) and the long term
evolution (15 years)
 Focal segmental glomerulosclerosis associated