Work

Kiesselbach’s area nasal septal gouty tophus with an integrated “3 + 2” diagnostic algorithm: a case report

Year: 2025

Type: article

Abstract: BACKGROUND: Gout, characterized by monosodium urate crystal deposition, rarely involves the nasal septum, with only a few reported cases. Such unusual presentations can mimic other conditions, necessitating prompt and accurate diagnosis. This report describes a rare case of gouty tophus in Kiesselbach's area of the anterior nasal septum. CASE PRESENTATION: A 59 year-old Han Chinese man with a 20/year history of gout, off urate-lowering therapy, presented with painless external nasal swelling. Imaging, including computed tomography (110-220 Hounsfield units calcified nodule) and dual-energy computed tomography (confirmed monosodium urate deposition), combined with histopathology, validated tophaceous gout. He underwent open surgical excision and received postoperative urate-lowering therapy, achieving no recurrence at 9 months with serum urate < 300 μmol/l. CONCLUSION: This case highlights the importance of considering gouty tophus in atypical nasal masses, especially in patients with gout history. Dual-energy computed tomography is a valuable diagnostic tool. We propose a practical "3 + 2" diagnostic algorithm to aid early recognition, although further validation in larger series is needed.

Source: Journal of Medical Case Reports

DOI: 10.1186/s13256-025-05691-4

Authors: Weikun Chen, Wanling Chen, Duanyue Guo, Ziyue Wang, Ziwen Shi, Junwei Zhong

Institutions: Sun Yat-sen University, Sun Yat-sen Memorial Hospital

Language: English

Topic: Gout, Hyperuricemia, Uric Acid

Subfield: Nephrology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,890