Kiesselbach’s area nasal septal gouty tophus with an integrated “3 + 2” diagnostic algorithm: a case report

Background Gout, characterized by monosodium urate crystal deposition, rarely involves the nasal septum, with only a few reported cases. Such unusual presentations can mimic other conditions, necessitating prompt and accurate diagnosis. This report describes a rare case of gouty tophus in Kiesselbach’s area of the anterior nasal septum. Case presentation A 59 year-old Han Chinese man with a 20/year history of gout, off urate-lowering therapy, presented with painless external nasal swelling. Imaging, including computed tomography (110–220 Hounsfield units calcified nodule) and dual-energy computed tomography (confirmed monosodium urate deposition), combined with histopathology, validated tophaceous gout. He underwent open surgical excision and received postoperative urate-lowering therapy, achieving no recurrence at 9 months with serum urate < 300 μmol/l. Conclusion This case highlights the importance of considering gouty tophus in atypical nasal masses, especially in patients with gout history. Dual-energy computed tomography is a valuable diagnostic tool. We propose a practical “3 + 2” diagnostic algorithm to aid early recognition, although further validation in larger series is needed.