First case of an intramuscular deposition of gouty tophy

Gout is a systemic disease characterized by the deposition of monosodium urate (MSU) crystals in synovia and periarticular tissues. Increased uric acid in blood is a requirement for this condition [10]. Acute gout leads typically to the inflammation of a single peripheral joint. In chronic gout the occurrence of gouty tophy is pathognomonic [7].

Manifestation of chronic tophacous gout in the head and neck area other than auricular helix is rare [2]. It presents with unspecific symptoms and can mimic a tumor, inflammation or other, for the affected organ more common entity. In the consequence, it is frequently misdiagnosed [1,11]. To this date single cases of tophacous deposits in the middle ear, nasal bridge, larynx, cricoarytenoid and temporomandibular joints have been described [1-6,8,9,12].

We present the first case of tophacous deposit in a muscle. It concerns a 77-year-old patient, who underwent a tracheotomy. While dissecting the straight neck muscles a white chalky mass was found. After surgical excision, it was sent for histopathological examination. The result revealed an intra-muscular gouty tophy. Although the patient’s medical history was significant for gout, it was an incidental finding.

Tophacous gout can occur in unexpected locations. In patients with chronic gout presenting atypical mass formation, a tophacous deposit should be included into differential diagnosis.

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Artikel online veröffentlicht:
10. Juni 2020