Painless gouty tophus in the nasal bridge

Chen, Shih-Lung; Chen, Jim-Ray; Yang, Shih‐Wei

doi:10.1097/md.0000000000014850

Cited by 11 publications

(8 citation statements)

References 21 publications

(37 reference statements)

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“…The mean age of onset of gouty arthritis in patients included in the present study was 47.96 ± 12.45 years compared to the mean age of onset of 48.28 years previously reported in a similar study in China, confirming a younger age of onset of gouty arthritis [ 26 ]. Urate crystals are deposited in high concentrations in the joints and surrounding soft tissues with the first joints primarily being the toe and finger joints followed by ankle joints, knee joints, back of the foot, finger joints, and elbow joints [ 27 , 28 ]. When gout stones form, they seriously affect the patient’s life and reduce the quality of life [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Correlation analysis of serum TLR4 protein levels and TLR4 gene polymorphisms in gouty arthritis patients

Liu,

He,

Jia

et al. 2024

PLoS ONE

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Objective The Toll-like receptor (TLR) 4-mediated nuclear factor kappa B (NF-κB) signaling pathway regulates the production of inflammatory factors and plays a key role in the pathogenesis of gouty arthritis. The aim of the present study was to investigate the link among TLR4 gene polymorphisms at various loci, protein expression, and gouty arthritis susceptibility. Methods Between 2016 and 2021, a case-control study was used to collect a total of 1207 study subjects, including 317 male patients with gouty arthritis (gout group) and 890 healthy males (control group). The association between gout susceptibility and different genetic models was analyzed by typing three loci of the TLR4 gene (rs2149356, rs2737191, and rs10759932) using a multiplex point mutation rapid assay, and the association between protein expression and gout was confirmed by measuring TLR4 protein concentrations using enzyme-linked immunosorbent assays (ELISAs). Results In a codominant models AA and AG, the rs2737191 polymorphism in the gout group increased the risk of gout compared to the AA genotype (OR = 2.249, 95%CI 1.010~5.008), and the risk of gout was higher for those carrying the G allele compared to the A allele (OR = 2.227, 95%CI 1.006~4.932). TLR4 protein expression was different between the two groups with different locus genotypes. The differences in TLR4 protein expression between the gout group and control group were statistically significant between the following genotypes: the GG and GT genotypes of the rs2149356 polymorphism; the AA and AG genotypes of the rs2737191 polymorphism; and the TT and TC genotypes of the rs10759932 polymorphism(P<0.05). The TLR4 protein level in the gout group (19.19±3.09 ng/ml) was significantly higher than that in the control group (15.85±4.75 ng/ml). Conclusion The AG genotype of the TLR4 gene rs2737191 polymorphism may be correlated with the development of gouty arthritis. The level of TLR4 protein expression is significantly higher in patients with gouty arthritis than in controls, and there is a correlation between high TLR4 protein expression and the development of gouty arthritis.

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Section: Discussionmentioning

confidence: 99%

Correlation analysis of serum TLR4 protein levels and TLR4 gene polymorphisms in gouty arthritis patients

Liu,

He,

Jia

et al. 2024

PLoS ONE

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“…Gout is increasingly recognized as a systemic urate deposition disease and can involve extra-articular deposition into soft tissue, tendons, and even cardiovascular tissue [2]. However, gouty tophus with nasal bone destruction is still extremely rare with only a few cases noted in literature [3]. Pathology can confirm monosodium urate crystals [4].…”

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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“…Presentation of gout in the head and neck region is rare. According to a literature review, there were 7 documented cases of gouty tophus in the nasal bridge from 1978 to 2018 in English literature [5] . Other atypical locations of gout include sclera, nose, ears, heart valves, abdominal striae, and gouty panniculitis [4] .…”

Section: Discussionmentioning

confidence: 99%

“…In this case, our patient underwent rhinoplasty and excision of the nasal mass, from which the definitive diagnosis was made. Ultrasound guided fine needle aspiration cytology is a cosmetically less destructive alternative [5] .…”

Section: Discussionmentioning

confidence: 99%

Gouty tophus: Unusual case of nasal lump

Shiu

Cheng

Chan

et al. 2021

Radiology Case Reports

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Chronic tophaceous gout is a common disease but rarely found in the head and neck region. Here we report a case of a middle aged male who presented with a mass over the right side of the nasal bridge. CT of the paranasal sinuses revealed a tophi lesion in the right nasal bridge with erosion of the underlying nasal bone. The mass was excised and histologically confirmed to be a gouty tophus. This case report illustrates how a common disease presented in an uncommon location could pose a diagnostic challenge.

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Painless gouty tophus in the nasal bridge

Cited by 11 publications

References 21 publications

Correlation analysis of serum TLR4 protein levels and TLR4 gene polymorphisms in gouty arthritis patients

Correlation analysis of serum TLR4 protein levels and TLR4 gene polymorphisms in gouty arthritis patients

Gouty tophus erodes nasal bone

Gouty tophus: Unusual case of nasal lump

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