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Pathology of Gout of the Ear

Dr Sampurna Roy MD


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Gout is a common metabolic disease and is characterized by episodic acute and chronic arthritis caused by the deposition of monosodium urate   crystals in joints and connective tissues.

The most commonly involved joint is the first metatarsophalangeal joint.

It may also present with nonspecific complaints caused by gouty tophi in unusual sites of the body such as the spine, bone, and middle ear.

Calcification of ear auricles is an uncommon clinical sign which is associated to gout, local trauma, addisonian crisis, and several endocrine diseases.

Primary Gout :  90% of cases. Majority of cases (idiopathic) are due  to overproduction of uric acid. About 5% cases there is known enzyme defect. The disease is seen in conditions such as partial HGPRT deficiency.

Secondary Gout: 10% of cases. Associated with increased nuclei acid turnover such as leukemia. There is overproduction of uric acid with increased urinary excretion. Secondary Gout may be associated with chronic renal disease.

- Acute arthritis : Dense neutrophilic infiltrate in synovium and fluid
Monosodium urate crystals within neutrophil cytoplasm.

- Chronic tophaceous arthritis : Hyperplastic synovium with inflammatory cells and fibrosis, heavily encrusted with urate crystals.

Visit:  Gouty Tophus ; Case history and images  

- Tophi :  Pathognomonic hallmark of gout. Large aggregations of urate crystals surrounded by epithelioid histiocytes and mononuclear cells and foreign body giant cells.

Differential diagnosis:  Pseudogout  ;  Elastotic nodules of the ears may be diagnosed clinically as basal cell carcinoma, amyloid or even gout.

Although elastotic nodules are usually found on the antihelix of the ear, they may arise on the helix and simulate chondrodermatitis nodularis helicis.

Unusual localizations of gouty tophi have been reported in the literature. Gouty tophi should also be considered in the differential diagnosis of middle ear masses alongside common lesions.


Further reading:

Pseudocarcinomatous hyperplasia involving the ear from gout: a diagnostic pitfall.

An Unusual Presentation of Gout: Tophi in the Middle Ear.

Tophaceous gout and pseudogout of the middle ear and the infratemporal fossa: case report and review of the literature.

Tophaceous gout of the middle ear.

Gout with auricular tophi following anti-tuberculosis treatment: a case report.

Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 40-1983. Preauricular mass five years after treatment of a brain tumor.

Infratemporal gout tophus--a rare differential diagnosis in primary parotid gland disease .

 A gouty tophus in the temporomandibular joint and on the eustachian tube .


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Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)







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