A Unique Case of Infected Laryngeal Tophi With Underlying Gout

Gout is a disorder of purine metabolism described by the deposition of monosodium urate crystals with rare involvement in the head and neck. This is the first laryngeal gout case reported in Sabah, Malaysia. A 50-year-old gentleman with a long history of gouty arthritis presented with acute painless anterior neck swelling for two weeks. An ultrasound of the neck was done, which showed a midline neck mass with intralesional calcification of the cartilaginous component with suspicious erosion of the thyroid cartilage, which was suggestive of thyroid chondroma. However, a computed tomography (CT) scan of the neck showed the fluid collection in the subperichondrium of anterior thyroid cartilage with amorphous calcification, which raised suspicion of infected laryngeal gout. Based on histology and intraoperative findings, laryngeal gout was diagnosed as noted multiple tophy crystals. Microscopic examination confirmed birefringent crystalline deposits. The pathophysiology and management of this rare clinical entity are discussed. We reported this case due to its rarity as well as to increase awareness of laryngeal gout.