Gout with auricular tophi following anti-tuberculosis treatment: a case report

Abstract

BackgroundAuricular tophi are firm deposits of monosodium urate in crystal form, which may slowly develop in subcutaneous tissue of the ear. Ear is not usual locations for gout tophi, but when this growth does occur, helix and the antihelix are common sites.Case presentationWe present a 64-year-old man who had multiple painless nodules over bilateral helix. An excisional biopsy was performed. Hematoxylin-eosin staining of biopsy specimens revealed a proteinaceous matrix that surrounded dissolved crystals, consistent with gout tophi. Bilateral auricular tophi are not common and may resemble a number of other diseases including squamous cell carcinomas, Kaposi’s sarcoma, epidermal and dermoid cysts, rheumatoid nodules. Biopsy should be performed to rule out malignancy.ConclusionsTophi of the auricle are usually asymptomatic but can become inflamed and occasionally ulcerate through the overlying skin. Chronic tophaceous gout is treated with dietary control and medication. Surgical excision is performed under local anesthetic if symptoms progression or cosmetically deformity is concerned.

Auricular Multiple Tophi Presenting as Painful Bilateral Nodules: A Case Report and Literature Review

“…Clinically, the differential diagnosis included sebaceous cyst, epidermal and dermoid cyst, chondrodermatitis nodularis helicis, actinic keratosis, keloid, verruca vulgaris, amyloids, elastotic nodules, weathering nodules, rheumatoid nodules, sarcoid nodules, tophaceous gout, sarcoidosis, leishmaniasis, leprosy, skin neoplasia including hemangioma, keratoacanthoma, chondroma, lipoma, schwannoma, neurolimemmoma, or even malignancies such as basal cell caricinoma or squamous cell caricinoma. 7) A pathological examination is important to rule out the possibility of malignancy. In this case, we were able to suspect AT from the beginning, because a thorough questioning of medical history revealed that the patient had a long standing history of uncontrolled gout.…”

“…6) However, a PubMed search yielded just a few articles specifically addressing ATs (Table 1). [1][2][3]5,[7][8][9][10][11][12][13][14] Interestingly, all of the patients were male. Gout itself, is more common in males.…”

“…When histopathologically examined, they appear as a pale basophilic granular matrix surrounded by needlelike space. 7) These radially arranged spaces represent outlines of uric acid crystals that have been dissolved by formalin. Fixation in alcohol is more helpful in identifying uric acid crystals and hence, we should consider submitting excised specimens suspected to be gout tophi in both formaldehyde and ethanol.…”

Asymptomatic Papules and Subcutaneous Nodules as First Sign of Gout

“…Patients with gout may also present a cutaneous involvement, characterised by the development of intradermal or subcutaneous nodules as a sign of the tophi deposition. They are typically described in avascular tissues, such as in the ears (helix and antihelix areas) or in the periarticular acral areas, where they are often associated with an involvement of bursae or tendons [ 12 , 13 ].…”

Auricle Pain Due to Tophi

“…Increasing the dose of febuxostat ameliorated the nodule by reducing the serum UA for five months. Since auricular nodules are involved in various disorders, including skin neoplasms, rheumatoid arthritis and sarcoidosis, a biopsy should be performed (1). Despite his refusing a biopsy, pinna tophus was diagnosed given that the nodule had developed on the antihelix and disappeared with urate reduction.…”