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Rare Manifestation of Gout

Gouty Tophi in the Nose

IIliev, Georgi, MD, PhD*; Ivanova, Polina Petrova*; Nedev, Plamen, MD, PhD*; Popov, Hristo, MD

doi: 10.1097/SAP.0000000000001778
Head and Neck Surgery

Gout is a disease characterized by abnormal metabolism of the uric acid, leading to undesired buildup of monosodium urate crystals affecting mainly the first metatarsal-phalangeal joint of the foot and less commonly other joints or the soft tissues of the body. The prevalence of the disease increases with age, and it is statistically more observed in men than in women.

We present the case of a 62-year-old male patient diagnosed as having gout 20 years ago. He came to the clinic with a nasal hump and a mass growing in his nose for the last 3 years, presenting as a nasal obstruction and facial deformity. Although the patient was treated with allopurinol and nonsteroidal anti-inflammatory drugs, surgical treatment was deemed necessary, and the patient was taken to receive a surgical resection of the nasal mass. The follow-up histopathology observation revealed deposits of urate crystals surrounded by a granulomatous inflammation. This confirmed the diagnosis—gouty tophi in the nose. In the follow-up period after the surgery, the patient reported overall improved breathing and aesthetic results.

Tophi can be found in atypical locations, which increases morbidities and deformities caused by the disease. We report on this peculiar case of tophaceus gout as it is—a rare manifestation of the disease with tophi located in the nasal region.

From the *ENT Department and

Clinic of General and Clinical Pathology, University Hospital Saint Marina—Varna, Medical Universiry of Varna, Varna, Bulgaria.

Received September 26, 2018, and accepted for publication, after revision October 26, 2018.

Conflict of interest and sources of funding: none declared. The authors have no financial, consultative, institutional, and other relationships that might lead to bias or conflict of interest. The authors declare no sources of funding.

Consent: Written informed consent was obtained from the patients for publication of this case report and accompanying images.

Reprints: Polina Petrova Ivanova, ENT Department, University Hospital Saint Marina—Varna, Medical University of Varna, Bulgaria Hristo Smirnenski Blvd, 9010 Varna, Bulgaria. E-mail:

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