Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Nov 24;16(11):e74363.
doi: 10.7759/cureus.74363. eCollection 2024 Nov.

A Unique Case of Infected Laryngeal Tophi With Underlying Gout

Muhammad Hazeem Akashah  1 , Siti Hajar Sanudin  1 , Charlene P Malakun  1
Affiliations
Case Reports

A Unique Case of Infected Laryngeal Tophi With Underlying Gout

Muhammad Hazeem Akashah et al. Cureus. .

Abstract

Gout is a disorder of purine metabolism described by the deposition of monosodium urate crystals with rare involvement in the head and neck. This is the first laryngeal gout case reported in Sabah, Malaysia. A 50-year-old gentleman with a long history of gouty arthritis presented with acute painless anterior neck swelling for two weeks. An ultrasound of the neck was done, which showed a midline neck mass with intralesional calcification of the cartilaginous component with suspicious erosion of the thyroid cartilage, which was suggestive of thyroid chondroma. However, a computed tomography (CT) scan of the neck showed the fluid collection in the subperichondrium of anterior thyroid cartilage with amorphous calcification, which raised suspicion of infected laryngeal gout. Based on histology and intraoperative findings, laryngeal gout was diagnosed as noted multiple tophy crystals. Microscopic examination confirmed birefringent crystalline deposits. The pathophysiology and management of this rare clinical entity are discussed. We reported this case due to its rarity as well as to increase awareness of laryngeal gout.

Keywords: head and neck region; larynx; monosodium urate crystals; purine; tophaceous gout.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Anterior (A) and lateral view (B) of neck swelling confined to the level of thyroid cartilage area (white arrow)
Figure 2
Figure 2. Axial view: Contrasted CT scan of the neck showing density fluid collection arising from perichondrium anterior to thyroid lamina with amorphous and multilobulated course calcification seen with erosion bilateral thyroid cartilage (white arrow) (A)
Sagittal view: Contrasted CT scan of the neck showing collection extended into pre-epiglottic space (white arrow) (B).
Figure 3
Figure 3. Coronal (A) and axial view (B) Contrasted CT scan of the neck showing periarticular calcification at the bilateral sternoclavicular joint (black arrow)
Figure 4
Figure 4. Thick pus with multiple tophi crystal (black arrow)
Figure 5
Figure 5. Tophy crystal measuring 1.4 cm
Figure 6
Figure 6. Examination under the microscope showing negative birefringent crystals (black arrow)
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Pathologic findings in gouty cricoarytenoid arthritis. Goodman M, Montgomery W, Minette L. Arch Otolaryngol. 1976;102:27–29. - PubMed
    1. Clinical features of gout. Grassi W, De Angelis R. Reumatismo. 2012;63:238–245. - PubMed
    1. Painless gouty tophus in the nasal bridge: A case report and literature review. Chen SL, Chen JR, Yang SW. Medicine. 2019;98:0. - PMC - PubMed
    1. The gouty tophus: A review. Chhana A, Dalbeth N. Curr Rheumatol Rep. 2015;17:19. - PubMed
    1. Gouty tophus: Unusual case of nasal lump. Shiu WH, Cheng HM, Chan YT, Chu CY, Kan WK. Radiol Case Rep. 2021;16:2904–2907. - PMC - PubMed

Publication types

LinkOut - more resources