Disseminated cutaneous gout: a rare manifestation of a common disease

Disseminated cutaneous gout is a rare atypical cutaneous manifestation of gout in which widespread dermal and subcutaneous tophi develop at extra-articular body sites. Given the lack of joint involvement that is typically a feature in tophaceous gout, the diagnosis may not be initially suspected. We present the case of a 50-year-old Hispanic man with poorly controlled gout who was evaluated for several years of firm papulonodules over the trunk and upper and lower extremities, sparing the joints; histopathology confirmed, the diagnosis of disseminated cutaneous gout. Per our literature review, disseminated cutaneous gout presents with polymorphous papules and nodules that can mimic other, more common cutaneous diseases. There is a preponderance of cases in males, Asians, and patients with longstanding gout. The lower extremities are involved in nearly all reports. Uric acid-lowering therapy with allopurinol has been reported to decrease the size and number of lesions in a minority of treated patients

Folliculotropic and syringotropic mycosis fungoides mimicking basal cell carcinoma

Mycosis fungoides (MF) is characterized by a clonal proliferation of skin-homing mature T cells with special predilection for involving the epidermis. Folliculotropic and syringotropic MF typically present with erythematous papules, patches, and plaques, with punctate accentuation that is folliculocentric in the former. We report a 67-year-old woman, with an extensive history of allergic contact dermatitis, who was referred to the Mohs surgery clinic with a large pink plaque extending from the nasal bridge to the right upper medial cheek concerning for basal cell carcinoma. An outside punch biopsy showed benign basaloid follicular neoplasm. The patient was found to also have indurated erythematous plaques of the bilateral upper arms and erythematous scaly patches of bilateral arms and legs, abdomen, lateral trunk, buttocks, and groin. Owing to concern for possible cutaneous lymphoma, punch biopsies were performed which revealed the diagnosis of folliculotropic and syringotropic MF. Of note, folliculotropic and syringotropic MF are often, but not uniformly, characterized by a more aggressive disease course. This case highlights the importance of a high index of suspicion and awareness of all clinical and histopathologic pitfalls to avoid misdiagnosis of MF

Disseminated cutaneous gout: a rare manifestation of a common disease

Disseminated cutaneous gout is a rare atypical cutaneous manifestation of gout in which widespread dermal and subcutaneous tophi develop at extra-articular body sites. Given the lack of joint involvement that is typically a feature in tophaceous gout, the diagnosis may not be initially suspected. We present the case of a 50-year-old Hispanic man with poorly controlled gout who was evaluated for several years of firm papulonodules over the trunk and upper and lower extremities, sparing the joints; histopathology confirmed, the diagnosis of disseminated cutaneous gout. Per our literature review, disseminated cutaneous gout presents with polymorphous papules and nodules that can mimic other, more common cutaneous diseases. There is a preponderance of cases in males, Asians, and patients with longstanding gout. The lower extremities are involved in nearly all reports. Uric acid-lowering therapy with allopurinol has been reported to decrease the size and number of lesions in a minority of treated patients

Cryptococcal cellulitis on the shin of an immunosuppressed patient

Cryptococcus neoformans is a common fungus found throughout the environment that causes opportunistic disease in immunocompromised individuals. Infection of humans with C neoformans usually manifests as lung disease through inhalation of spores or meningoencephalitis by involvement of the central nervous system. Rarely, dissemination in the form of cutaneous lesions can occur in individuals with long term immunosuppression. We present a patient with C. neoformans manifesting as cellulitis with focal segmental glomerulosclerosis treated with corticosteroids. Because of the mortality associated with disseminated cryptococcosis, early identification, especially of atypical cutaneous presentations is critical from a dermatological perspective