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

Abstract

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.

Painless gouty tophus in the nasal bridge

“…Wu et al stated the patients with nasal tophi in the literature are more likely to be male and middle aged. [ 12 ] Our finding was in accordance with theirs (Table 1 ). They concluded that surgery was indicated for cosmetic purposes or recalcitrant symptoms, such as nasal obstruction or difficulty breathing.…”

“…We reviewed all case reports regarding a tophus of the nasal bridge in English-language literature, and the painless characteristic was often described (Table 1 ). [ 3 , 7 – 12 ] Nevertheless, other types of pathology within the nasal bridge could contribute to a painful sensation. [ 13 ]…”

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

Systemic Urate Deposition: An Unrecognized Complication of Gout?

“…These patients often presented with hoarseness, odynophagia, dysphagia or stridor [ 89 ]. Four cases of nasal MSU deposits have been reported manifesting as a nasal mass, which in some cases led to osseous destruction [ 90 ].…”

Perturbing purinergic signaling: A pathogen's guidebook to counteracting inflammatory responses

“…Wu et al. [39] report a rare case of gout affecting the nasal region and leading to nasal obstruction and bone destruction. This case highlights the importance of taking a detailed medical history, especially since gout can mimic malignancy, unrelated diseases and infection.…”