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To the Editor: Gout is characterized by extracellular fluid urate saturation leading to monosodium urate (MSU) crystal deposition. Typically, it manifests as recurrent acute inflammatory arthritis flares that may lead to a chronic tophaceous destructive arthritis. MSU crystal deposition usually occurs in articular and periarticular areas. MSU crystals are found in cartilage, tendon sheaths, synovial fluid, and subcutaneous tissue1. A cutaneous pustule-like rash filled with tophaceous material is a rare presentation of gout. We describe a patient with gouty arthritis presenting with an asymptomatic cutaneous diffuse rash consisting of pustule-like lesions containing tophaceous material.A 30-year-old man presented with a 6-year history of intermittent polyarticular arthritis involving the knees bilaterally, ankles bilaterally, left elbow, right fifth metacarpophalangeal (MCP) joint, and left olecranon bursitis. In addition, he had a cutaneous diffuse rash. He failed to provide a clear history regarding the time onset of the rash and its course. He did not report any pruritus, tenderness, or pain secondary to his rash. He was diagnosed as having rheumatoid arthritis by his primary doctor and was treated with naproxen, without improvement.He had no other known medical history. There was no family history of gout or kidney stones. He did not … Address correspondence to Dr. Schlesinger; E-mail: schlesna{at}umdnj.edu

Tophaceous Pustule-like Rash in a Patient with Gout