Professor Carmen Salavastru, MD, PhD, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;
Acta Dermatovenerol Croat. 2020 Dec;28(7):223-227.
Gout represents a metabolic disorder with systemic echo, in which needle-like crystals of monosodium urate are deposited in various tissular structures. Crystals accumulation in the connective tissue (tophi) represents the late, chronic stage of this disease, usually emerging after an average of 10 years after disease onset. Herein we report three cases of patients aged 70, 33, and 53 who presented with painful subcutaneous nodules located on various body areas. All of them had hyperuricemia. Several conditions had to be investigated in order to establish the etiology of uric acid metabolism alterations. Laboratory and pathology findings established the diagnosis of gout, with tophi as the first symptom of the disease. Following patient education, diet and lifestyle changes, and medication, the outcome in all patients was favorable, with alleviation of the symptoms. Tophaceous gout as a first presentation of this disease is currently uncommon, but dermatologist should be aware of this rare finding for proper management of such cases and to prevent the resultant significant functional and quality of life impairment if not recognized early.
痛风是一种具有全身影响的代谢性疾病，其中单钠尿酸盐的针状晶体沉积在各种组织结构中。晶体在结缔组织（痛风石）中的积累代表了这种疾病的晚期、慢性阶段，通常在发病后平均 10 年出现。在此，我们报告了 3 例年龄分别为 70 岁、33 岁和 53 岁的患者，他们均表现为位于身体不同部位的疼痛性皮下结节。所有患者均有高尿酸血症。为了确定尿酸代谢改变的病因，需要对多种情况进行调查。实验室和病理检查结果确立了痛风的诊断，痛风石是该病的首发症状。对患者进行教育，改变饮食和生活方式，并进行药物治疗后，所有患者的病情均有所好转，症状得到缓解。痛风石性痛风作为该病的首发表现目前并不常见，但皮肤科医生应认识到这种罕见表现，以便对这些病例进行适当的管理，并预防因早期未识别而导致的严重功能和生活质量受损。
