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Arch Dermatol. 2007;143(9):1201-1206.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Diagnosis: Chronic tophaceous gout.

MICROSCOPIC FINDINGS AND CLINICAL COURSE

The biopsy specimen revealed amorphous pink to gray material in the dermis, surrounded by lymphocytes and multinucleated foreign body–type giant cells, with no evidence of vasculitis or panniculitis. A von Kossa stain was negative for calcium. These microscopic findings were consistent with a diagnosis of a gouty tophus. Laboratory data revealed normal levels of serum calcium and phosphorus and an elevated level of uric acid (12.2 mg/dL [to convert to micromoles per liter, multiply by 59.485]; reference range, 2.6-7.5 mg/dL).

Oral allopurinol therapy (100 mg every other day; alternate-day dosing because of renal failure) was initiated, and hemodialysis was started 3 months later. The patient's uric acid level decreased markedly to 5.6 mg/dL over a 5-month period. No new tophi have developed since the allopurinol therapy was begun. In this case, transepidermal elimination of the tophi caused multiple large ulcers and subsequent pyodermas that yielded methicillin-resistant Staphylococcus aureus and vancomycin-resistant . . . [Full Text of this Article]

DISCUSSION

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Arch Dermatol. 2007;143(9):1201-1206.
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