title: Nasal gout presenting as nasal obstruction.
abstract: OBJECTIVE
  We describe a case of nasal gout presenting as nasal obstruction, a rare etiology for a common presentation.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Bobby R. Alford Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, TX 77005, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Kwak
authors.forename: Blythe K
authors.initials: BK
authors.lastname: Gorman
authors.forename: Krista L
authors.initials: KL
authors.lastname: Olson
mesh_terms: D003937:Diagnosis, Differential; D006073:Gout / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D009667:Nose Deformities, Acquired / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012225:Rhinoplasty / Q000379:methods*