Images in Dermatology
Long-Standing Gouty Panniculitis
Paniculitis gotosa de larga evolución
T. Ródenas-Herranz, L. Linares-González, R. Ruiz-Villaverde
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Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Instituto de Investigación Sanitaria (IBS) Granada, Granada, Spain
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"apellidos" => "Ruiz-Villaverde" "email" => array:1 [ 0 => "ismenios@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Instituto de Investigación Sanitaria (IBS) Granada, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paniculitis gotosa de larga evolución" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 617 "Ancho" => 1674 "Tamanyo" => 185652 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 53-year-old man with a history of gout was evaluated in the dermatology department for the presence of an ulcerated, densely friable nodule with a deposit of hard white material on the surface, without purulent discharge (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The nodule had appeared 6 months earlier. Soft tissue ultrasound revealed a heterogeneous mass with a lobulated border and hyperechoic trabecular structures (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Ultrasound examination of the right knee revealed minor effusion and the presence of the double contour sign, which is considered highly suggestive of urate deposition in the hyaline cartilage (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Histology showed amorphous basophilic material surrounded by a foreign-body-like giant-cell reaction with focal lymphohistiocytic infiltrate (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). Uric acid levels were 9.5<span class="elsevierStyleHsp" style=""></span>mg/dL (3.4–7.0<span class="elsevierStyleHsp" style=""></span>mg/dL). All other laboratory parameters were within the normal range. In terms of the pathophysiology of gouty panniculitis, venous stasis and pre-existing tissue damage are factors that, together with repeated microtrauma, make patients more predisposed to urate crystal deposition on subcutaneous tissue. 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