PMC9762070_01
Multiple cutaneous morphologies, which all revealed gout on histopathologic examination. A, Skin colored indurated dermal plaques, most discernible by palpation. B, Hyperpigmented plaque of the left back with superimposed punched-out appearing depressions. C, Mildly erythematous plaques studded with firm aggregations of a whitish gritty substance. D, Superficial erosion of the right leg extruding a whitish, gritty substance.
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The most numerous and prominent lesions were 5- to 12-cm, skin-colored to light brown, indurated dermal to subcutaneous plaques involving the arms, chest, back, and legs, most of which were discernible by palpation only (Fig 1, A). There was a single slightly hyperpigmented plaque on the upper lateral aspect of the left side of the back, with numerous superimposed 5- to 10-mm punched-out appearing depressions resulting in a moth-eaten appearance (Fig 1, B). There were scattered mildly erythematous plaques studded with 2- to 4-mm, firm rough-surfaced aggregations of a whitish gritty substance (Fig 1, C). On the lower portion of the left leg, there was a 2-cm superficial ulceration extruding a whitish gritty substance (Fig 1, D).
A, Ventral pterygium of multiple fingers. B, Close up of ventral pterygium.
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In addition, ventral pterygia of most fingernails (Fig 2) and bilateral enlargement of the lacrimal glands (Fig 3) were noted.
Lacrimal gland hypertrophy.
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In addition, ventral pterygia of most fingernails (Fig 2) and bilateral enlargement of the lacrimal glands (Fig 3) were noted.
Hematoxylin-eosin stain, 100x magnification (40x magnification inset) revealed gout in all punch biopsy specimens.
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Histology from all clinical morphologies revealed many feathery deposits of eosinophilic material surrounded by multinucleated cells in the dermis, characteristic of gout (Fig 4).