Nasal Gout Presenting as Nasal Obstruction

Kwak, Paul E.; Gorman, Blythe; Olson, Krista L.

doi:10.1001/jamaoto.2013.220

Cited by 9 publications

(6 citation statements)

References 3 publications

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“…Out of the five previously reported cases of nasal gouty tophus, three cases presented as a dorsal nasal mass with cosmetic appeal as the primary surgical indication. Two other cases, along with the patient we reported here, suffered from nasal obstruction symptoms caused by nasal tophus [3] , [4] , [5] , [6] , [7] . All previous five cases received surgical treatment for their nasal gouty tophus.…”

Section: Discussionsupporting

confidence: 51%

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Nasal gouty tophus: Report a rare case presenting as a nasal hump with nasal obstruction

Chou

Chen

2016

Biomedical Journal

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Dorsal nasal gouty tophus are rare occurrences with limited documentation. Here we report a male patient who has a history of poorly controlled gouty arthritis. He had nasal obstruction with an enlarging mass over his left nasal ridge for the past three years. Image studies revealed a nasal bone defect underneath the nasal lesion. The firm mass was excised and confirmed to be of gouty origin. The nasal bone defect was repaired with a titanium mesh plate to prevent nasal depression. He has fully recovered with no more nasal obstruction or recurrence of nasal tophus. The case report illustrates a common illness, gout, with a rare clinical manifestation leading to a common symptom, nasal obstruction. It demonstrates the importance of a detailed history, a thorough physical examination and most important of all, an extensive differential diagnosis in our clinical practice.

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Section: Discussionsupporting

confidence: 51%

“…Rarely, however, has there been cases reported that involved the nasal region. There are five cases of documented nasal gouty tophus, with two of them presenting as nasal obstruction, while the other three cases were identified as esthetic problems [3] , [4] , [5] , [6] , [7] .…”

mentioning

confidence: 99%

Nasal gouty tophus: Report a rare case presenting as a nasal hump with nasal obstruction

Chou

Chen

2016

Biomedical Journal

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“…Ultrasound findings of gout such as a double-contour sign (a hyperechoic line of MSU crystals overlying cartilage) or “wet clumps of sugar” are well described in literature and may spare need for invasive tissue confirmation in the appropriate clinical setting [ 5 ]. Apneic symptoms can improve with medical treatment alone as nasal tophi decreases; however, some cases of refractory nasal obstruction and septal deviation have required surgical excision [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Gouty tophus erodes nasal bone

2021

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A 45-year-old Asian man with a 20-year history of gout is seen in clinic after lost to follow up for 10 years. He was previously treated with allopurinol but had been off therapy for many years. He describes several weeks of nasal bridge swelling with new episodes of snoring and apnea. On exam, he has a tender, erythematous mass over dorsum of nose with bulky tophi of multiple joints on hands, elbows, knees, and feet. Point-of-care ultrasound of his nasal bridge shows an area of inhomogeneous, hyperechoic aggregation with a hypoechoic rim consistent with gouty tophus [1]. Sinus CT without contrast shows a soft tissue partially calcified mass with bilateral nasal bone erosions. His uric acid was 12.6 mg/dl. This case is a rare presentation of gouty tophi causing nasal bone erosions. The patient tested negative for hereditary enzyme deficiencies. He did test positive for HLA-B*5801 putting him at risk for allopurinol hypersensitivity syndrome. He was treated with febuxostat and eventually pegloticase infusions. With urate lowering therapy, his nasal mass size decreased, and apnea improved without need for surgical intervention (Fig. 1).

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“…[11] Others revealed the history of gouty arthritis persisting for years, even under medical control (Table 1). [3,7–10,12]…”

Section: Discussionmentioning

confidence: 99%

“…Hughes et al [8] used intranasal transfixion and inter-cartilaginous incision with the endoscopic approach to remove the tophus. Kwak et al [10] created an external, inverted-V-shaped incision along the columella and dissected the subperichondrial plane to remove the tophus. The harvested septal cartilage was placed alone with remnant nasal septum to correct saddling.…”

Section: Discussionmentioning

confidence: 99%

Painless gouty tophus in the nasal bridge

Chen

Yang

2019

Medicine

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Rationale:A gouty tophus, arising from the deposition of monosodium urate crystals (MSU), rarely occurs in the nasal bridge. There have been only 7 documented cases of a gouty tophus in the nasal bridge from 1978 to 2018 in English-language literature.Patient concerns:A 65-year-old male had a chief complaint of a lump in the nasal bridge that was slowly growing for over 1 year.Diagnosis:MSU crystals were confirmed through ultrasonography (US) and pathological examinations.Interventions:A cosmetically less destructive method, ultrasound-guided fine needle aspiration cytology (FNAC) was used to approach the mass lesion of nasal bridge.Outcomes:The diagnosis was confirmed as a gouty tophus without performing a nasal subdermal exploration.Lessons:This case report is the first use of US with FNAC to approach and diagnosed a gouty tophus in the nasal bridge.

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Nasal Gout Presenting as Nasal Obstruction

Cited by 9 publications

References 3 publications

Nasal gouty tophus: Report a rare case presenting as a nasal hump with nasal obstruction

Nasal gouty tophus: Report a rare case presenting as a nasal hump with nasal obstruction

Gouty tophus erodes nasal bone

Painless gouty tophus in the nasal bridge

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