Miliarial-type gout in association with chronic use of glucocorticoids

A 59-year-old male patient with long-standing tophaceous gout (more than 30 years) characterized by polyarticular involvement and recurrent disseminated tophi formation; his past medical history is relevant for poor adherence to urate-lowering medications, as well as persistent use of self-prescribe...

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Bibliographic Details
Published in:Rheumatology international 2024-03, Vol.44 (3), p.543-547
Main Authors: Enríquez-Luna, A., Soto-Fajardo, C., Carranza-Enríquez, F., Clavijo-Cornejo, D., Lopez-Reyes, A., Pineda, C.
Format: Article
Language:English
Subjects:
Arthritis, Gouty
Case Based Review
Glucocorticoids - therapeutic use
Gout - complications
Gout - drug therapy
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Rheumatism
Rheumatology
Uric Acid
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Summary:A 59-year-old male patient with long-standing tophaceous gout (more than 30 years) characterized by polyarticular involvement and recurrent disseminated tophi formation; his past medical history is relevant for poor adherence to urate-lowering medications, as well as persistent use of self-prescribed systemic glucocorticoids. Despite achieving therapeutic goals for serum uric acid levels, new tophi formation with an intradermal location in the form of “miliarial-type gout” was documented. Due to functional limitations, the patient underwent surgical resection of the olecranon bursa. This case illustrates a widespread and recurrent tophi formation associated with long-standing gout and regular and sustained glucocorticoid use, despite an adequate disease control based on serum urate levels and involving an intradermal location of tophi presenting as “miliarial-type” lesions. In addition, the coexistence of urate and cholesterol crystal deposition disease in olecranon gouty bursitis is presented. Finally, a sonographic extended field of view of lesions distributed along the patient’s extremities is presented as a novel characterization of this condition.
ISSN:1437-160X
0172-8172
1437-160X
DOI:10.1007/s00296-023-05486-0