Tophi Beneath Seed Corns...What The?

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I have a real weird case, a young Lady , Healthy, came in for sore plantar forefoot and I examined them and found some standard looking seed corns, scattered in some pinch callous and randomly on some other areas. I stared the usual debridment of the Overlying corns and found the lower skin layers (beneath the corns) looked.....macerated, and tophi like (if theres such a word). so I had more of a poke around and a squeeze (as you do) and out comes some pus like substance and some crystal like chunks (about the size and texture of Gouty Tophi) but darker in colour to Gouti Tophi. Wow I thought I have never seen this before. so I showed the Pt and she place some between her finger nails and squeezed it and said it felt like sand and crushed really easily, I have dealt with Gouty Tophi crystals before but these seem different. The Pt is and Ex smoker, Family Hx of Gout (Dad), normal diet, normal weight. I sent her for a Uric acid blood test which came back normal. Has anyone any Idea what these Weird (Pustal / Calcification thingys might be)


Cheers

Joe Wheeler

 

No idea! Can you get a swab?

 

I am pretty Bl...y stupid, I should have thought of that at the time, I will probably see the Pt in a few Months for Debridment , so Ill do it then. Simple things............, I might do some reading on the subject..

Thanks

Joe

 

Hi,

I just saw a case like this recently on a placement, and we have not yet gotten a swab report back. I was wondering what happened with this case??? did you get any results, or find an aetiology?

Any info would be great thanks.

Jaimee

 

No I have lost her to Follow up she may return to have the corns done again , Ill feedback then .......If I remember.''Cheers Joe