Two cases of miliarial gout: A rare variant of chronic tophaceous gout

Gout is a systemic disease characterized by recurrent arthritis associated with hyperuricemia and deposition of monosodium urate (MSU) crystals in joints, bones, and soft tissues. A rare variant is the deposition of MSU crystals in the skin. Among the variants of cutaneous gout, miliarial gout is the most unstudied and unreported due to its rarity. Two patients diagnosed with chronic tophaceous gout presented with multiple milia-like papules on the extremities. Skin biopsies revealed pale basophilic material deposited in the dermis, surrounded by an inflammatory infiltrate of lymphocytes, histiocytes, and multinucleated giant cells. Needle-shaped crystals noted correspond to uric acid crystals. These findings were consistent with miliary gout. Urate-lowering therapy is the mainstay treatment of gout. In this report, we highlight the clinical course, complications, cutaneous manifestations, laboratory abnormalities, and histopathological features of miliarial gout. These cases supplement the few that have been documented in the English-language literature.