An unusual location of gouty panniculitis: A case report

Abstract

Rationale: Gouty panniculitis, characterised by the deposition of monosodium urate crystals in subcutaneous tissue, is a rare clinical manifestation of gout.

Patient concerns: The case of a 67-year-old man is reported, who presented an erythematous nodule on the upper part of the right buttock suspicious for an abscess. This was in the context of chemotherapy for non-Hodgkin's lymphoma.

Diagnoses: Histopathologic examination demonstrated gouty panniculitis.

Interventions: Because infection was suspected, an incision was performed. The lesion was found to be densely calcified and friable, without purulent discharge. Therefore, a surgical en-bloc resection was performed.

Outcomes: The wound healed slowly initially due to a combination of malnutrition, chemotherapy and infection. A wound infection with Enterococcus faecium was treated with antibiotic therapy (carbapenem for seven days) and local therapy. At 6-week follow up the wound showed good granulation tissue and was healing well by secondary intention. The patient was instructed to continue anti-hyperuricaemic treatment.

Lessons subsections: In patients known to have long-standing hyperuricaemia and gout with nonspecific subcutaneous erythematous nodules, gouty panniculitis should be considered.

Figure 1

Painful erythematous 3-cm nodule on the right buttock containing 2 yellow-white circular structures.

Figure 2

After incision: densely calcified and friable nodule.

Figure 3

(Magnification ×40): orthokeratotic hyperkeratosis of the epidermis (thin arrows). The deep dermis shows amorphous and acellular deposits containing dystrophic microcalcifications surrounded by a paucicellular fibrous capsule (thick arrows).

Figure 4

CT scan showing the presence of calcium deposits on the left buttock (same density as the femoral bone). CT = computed tomography.