Double Trouble: Gout meets Pyoderma Gangrenosum in a relapsing storm

Madalina-Pusa Rosu^(1,*), Valentina Petricescu⁽¹⁾, Cristiana Prefac⁽²⁾, Anca Ursu⁽³⁾, Constantin-Ioan Busuioc⁽⁴⁾, Denisa Predeteanu⁽¹⁾

1) Department of Rheumatology, “Sf. Maria” Clinical Hospital, Bucharest, Romania
2) Infectious Disease Department, “Sf. Maria” Clinical Hospital, Bucharest, Romania
3) Dermathology Department, “Sf. Maria” Clinical Hospital, Bucharest, Romania
4) Department of Pathology, "Sf. Maria" Clinical Hospital, Bucharest, Romania

Background: Pyoderma Gangrenosum (PG) is an uncommon neutrophilic skin condition often misdiagnosed as infectious skin ulceration. It’s association with gout is extremely rare and may complicate the clinical picture, especially when systemic inflammatory response is present. Although cases of coexisting PG and gout have been reported, the association between these two conditions remains unexplored.
Case Presentation: A 40-year-old man with recurrent untreated gout presented with acute ankle arthritis, fever, and a painful ulcerative lesion. Laboratory tests showed leukocytosis, elevated C-reactive protein, and hyperuricemia. Initial cultures grew Streptococcus spp., and the patient was treated for cellulitis secondary to gout. Despite antibiotics, the lesion progressed rapidly, forming extensive necrotic ulcers. Autoimmune and infectious causes were excluded. Skin biopsy demonstrated neutrophilic infiltration and dermo-hypodermal necrosis, confirming PG. High-dose oral methylprednisolone (64 mg/day) led to rapid improvement and re-epithelialization within one week.
Conclusion: This case underscores the importance of considering PG in non-healing ulcers unresponsive to antibiotics in patients with gout. Both conditions share IL-1–driven neutrophilic inflammation, which may explain their coexistence. Early recognition, biopsy, and prompt corticosteroid therapy are critical to avoid unnecessary surgery and prevent tissue loss. Multidisciplinary management ensures timely diagnosis and optimal outcomes.

Keywords: pyoderma gangrenosum, gout, ulcer, neutrophilic dermatosis

Corresponding author(s): Madalina Pusa Rosu, Department of Rheumatology, "Sfanta Maria" Clinical Hospital, Bucharest, Romania, email: madalina.duna@yahoo.com