Nasal Gouty Tophus Presenting as Nasal Obstruction: A Case Report

Introduction: Gout is an abnormality of uric acid metabolism as a consequence of an overproduction or underexcretion of purines. The resulting hyperuricemia leads to deposition of monosodium urate crystals in connective tissue of areas as articular bone, cartilage, and ligaments. Chronic tophaceous gout commonly affects peripheral soft tissues and joints. However, there have been described sites affected in the head and neck region, as larynx, ear, and tongue. Involvement of joint and cartilages of the nose is rare. There are four previously reported cases of dorsal nasal gouty tophus—three as an esthetic symptom and one as nasal obstruction.

Objectives: This study aims to report a rare condition, nasal gouty tophus, presented as an ordinary symptom, nasal obstruction, barely investigated by previous medical evaluations.

Report: We report a case of 61-year-old man with gouty tophus in the left and right nasal vestibuli that look for medical assistance presenting nasal obstruction. He referred a 5-year period of recurrent intermittent attacks of gouty arthritis, poorly treated, and an emergency of growing masses in both nasal vestibuli causing nasal obstruction. Anterior rhinoscopy evidenced two gouty tophi fixed in the inner surface of the lateral crus of the major alar cartilages. Biopsy of the lesions confirmed gout. We started an effective drug treatment and referenced him for rheumatologic evaluation.

Conclusion: This report exemplifies a rare manifestation of gout causing an ordinary symptom in our everyday practice. It enhances the importance of a detailed anamnesis, physical examination, and a broad differential diagnosis of patients presenting with nasal obstruction.