When Gout Masquerades as Miliaria: A Case Report and Literature Review of an Unusual Cutaneous Manifestation

We report a case of a 35-year-old male miner from Villa de Alvarez, Mexico, with a history of type 2 diabetes, hypertension, gout, and exogenous Cushing’s syndrome due to prolonged dexamethasone use. He presented with disseminated skin lesions, initially misdiagnosed as severe acne, and later found to be cutaneous gout. Physical examination revealed moon face, oral candidiasis, and violaceous striae, with papular and nodular skin lesions on the extremities and abdomen, accompanied by joint involvement and tophi. Blood tests showed elevated uric acid levels (9.5 mg/dL). Skin biopsy confirmed the diagnosis of cutaneous gout with MSU crystal deposits. Treatment with allopurinol resulted in significant improvement in skin lesions. This case highlights the importance of early diagnosis and appropriate treatment in preventing the progression of gout, particularly in patients with unusual cutaneous manifestations.