J Rheum Dis.  2015 Feb;22(1):25-28. 10.4078/jrd.2015.22.1.25.

Tophaceous Gout Misidentified as Inflammatory Polyp in External Auditory Canal

• Yoon MJ
• Oh HJ
• Ku BS
• Song YW
• Lee JH
• Lee EB

• KMID: 2222923
• DOI: http://doi.org/10.4078/jrd.2015.22.1.25

Abstract

Gout is an inflammatory disorder in which urate crystals are deposited in the joints or soft tissues causing severe inflammation and pain. Urate crystals usually deposit in the joints, and sometimes in the extra-articular sites. A 67-year-old woman visited the otolaryngology clinic due to otalgia and discharge from the ear. She had experienced recurrent arthritis in the left second metatarsophalangeal joint from five years ago. She visited the otolaryngology clinic of our university hospital due to persistent inflammation in the ear canal despite treatment with antibiotics. An otoscopic examination showed a polyp-like mass near the eardrum. Computed tomography scan of temporal bone showed thickening of the eardrum and increased soft tissue density in the external ear canal. On histologic examination the polyp was finally found to be a urate crystal mass. She is now in a good state with urate lowering therapy. We report on a Korean case of tophaceous gout in the external ear canal that was misidentified as an inflammatory polyp.

Keyword

Gout; Polyps; Ear canal

MeSH Terms

Aged
Anti-Bacterial Agents
Arthritis
Ear
Ear Canal*
Earache
Female
Gout*
Humans
Inflammation
Joints
Metatarsophalangeal Joint
Otolaryngology
Polyps*
Temporal Bone
Tympanic Membrane
Uric Acid
Anti-Bacterial Agents
Uric Acid

Figure

• 

  Figure 1. Otoscopic view of right external ear canal showed small polyp on the anterior wall of external ear canal and thickened tympanic membrane.

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  Figure 2. Computed tomography of right temporal bone showed soft tissue density in the external auditory canal. Arrow indicates polyp on anterior wall in the external auditory canal.

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  Figure 3. Histopathology of the polyp in external ear canal (postoperative biopsy, (A): H&E, ×100; (B) H&E, ×200) showed gran-ulation tissue with needle shaped crystal structure. Arrow indicates urate crystal.

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  Figure 4. Polarized microscopic image showed negative bi-refrigent needle-shaped crystals (H&E, ×400).

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