AMA Publishing Group: Inflammatory Disease of Head & Neck Topic Collection

Nasal Gout Presenting as Nasal Obstruction Nasal Gout Presenting as Nasal Obstruction

Kwak PE, Gorman BK, Olson KL. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

We describe a case of nasal gout presenting as nasal obstruction, a rare etiology for a common presentation.

Observations

We report a single case of a 56-year-old man with history of multiple nasal traumas, obstructive sleep apnea, referred for nasal obstruction and congestion, having failed attempts at medical management. He had severe septal deviation, elements of external and internal nasal valve collapse, and a nasal dorsal mass suspicious for gouty tophus. He was brought to the operating room for septorhinoplasty through an open incision with nasal tip reconstruction, which exposed a 4 × 3-cm mass on the nasal dorsum, extending to the tip, supertip, and into the septal plane at the level of the upper lateral cartilages. Final pathologic findings revealed gouty tophus. He has done well since, and breathing and sleep are significantly improved.

Conclusions and Relevance

This case demonstrates a rare etiology for nasal obstruction that may complicate the workup, evaluation, and management of such a patient. It highlights the ways in which a rare diagnosis adds complexity to the workup and management of a patient with nasal obstruction, and serves as an important reminder about rarer pathologies that can present in an everyday clinic.

Pathology Quiz Case 2

Miller RA, Spanos WC, Jassim AD. — Mon, 01 Apr 2013 00:00:00 GMT

A 20-year-old Native American man presented with a 13 × 8-cm disfiguring, exophytic postauricular mass (Figure 1) spanning from the right superior helix down to the nape of his neck. This mass reportedly began 4 years prior as recurrent papules and pustules that grew larger and coalesced. Two prior surgical excisions by a local physician and treatment with triamcinolone acetonide injections in combination with short courses of isotretinoin were unsuccessful. Cultures were negative for infectious organisms. The mass was widely excised, and the site was closed with a split-thickness skin graft harvested from the thigh.

Pathology Quiz Case 2: Diagnosis

Mon, 01 Apr 2013 00:00:00 GMT

Diagnosis: Folliculitis keloidalis nuchae.