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Background <p>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.</p> Case presentation <p>A 59&#xa0;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&#xa0;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&#xa0;months with serum urate &lt; 300&#xa0;μmol/l.</p> Conclusion <p>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.</p>

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

  • 期刊论文

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  • 发表日期：

    2025年11月28日

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

摘要

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.