Bobby R. Alford Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, TX 77005, USA.
JAMA Otolaryngol Head Neck Surg. 2013 Apr;139(4):411-3. doi: 10.1001/jamaoto.2013.220.
We describe a case of nasal gout presenting as nasal obstruction, a rare etiology for a common presentation.
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.
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.
我们描述了一例以鼻塞为表现的鼻痛风病例，这是一种罕见的病因引起的常见表现。
我们报告了一例 56 岁男性病例，他有多次鼻外伤史、阻塞性睡眠呼吸暂停，因鼻塞和充血就诊，曾尝试过药物治疗但未成功。他有严重的鼻中隔偏曲、外鼻和内鼻阀塌陷的表现，以及一个可疑为痛风石的鼻背肿块。他被带到手术室，通过开放切口行鼻中隔成形术和鼻尖重建术，术中暴露了一个 4×3cm 的肿块，位于鼻背，延伸至鼻尖、超鼻尖，并进入上外侧软骨水平的鼻中隔平面。最终的病理结果显示为痛风石。此后，他恢复良好，呼吸和睡眠明显改善。
本例展示了一种罕见的鼻塞病因，可能使此类患者的检查、评估和治疗变得复杂。它强调了罕见诊断如何为鼻塞患者的检查和治疗增加复杂性，并提醒人们注意在日常临床中可能出现的更罕见的病理情况。
