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Video

Comprehensive Otolaryngology

(A220) First-Ever Reported Case of Tophaceous Gout Presenting as a Multi-Loculated Head and Neck Collection

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Neil Kondamuri, MD

    Resident Surgeon
    University of Chicago
    Chicago, Illinois, United States

    • Co-Author(s)

  • Maximilian Hemmrich, MD

    Resident Physician (PGY-5)
    University of Chicago
    Chicago, Illinois, United States

  • Seth Krantz, MD

    Chief, Thoracic Surgery
    Endeavor Health Medical Group
    Evanston, Illinois, United States

    • Senior Author(s)

  • Sameer Alvi, MD

    Section Head of Head & Neck Surgery
    Endeavor Health Medical Group
    Northbrook, Illinois, United States

Disclosure(s):
Neil Kondamuri, MD: No relevant relationships to disclose.
Maximilian Hemmrich, MD: No relevant relationships to disclose.
Seth Krantz, MD: No relevant relationships to disclose.
Sameer Alvi, MD: No relevant relationships to disclose.


Introduction: A 54-year-old female presented with progressive left neck swelling for three days. She also endorsed left neck tenderness but denied difficulty breathing, voice changes, difficulty swallowing, chest pain, fevers, or chills. On examination, vital signs were stable. The left neck had firm induration and overlying erythema extending from the upper neck down to the sternum. Labs were notable for a leukocytosis of 11.6.

Methods: Computed tomography (CT) scan of the neck with contrast demonstrated a large multi-lobulated low-density cystic structure with peripheral enhancement and internal septations along the deep aspect of the left sternocleidomastoid (SCM) muscle. It also appeared to involve the sternoclavicular joint.

Results: The patient was taken to the operating room for incision and drainage. Multiple collections were explored deep to the SCM with immediate return of thick, creamy, white fluid without odor. The cavity was widely irrigated. An abnormal cystic structure was found protruding from the left sternoclavicular joint. Given the inferior extent on scan, thoracic surgery was on standby and joined the case. A Gigli saw was used to resect the clavicular head. The wound was irrigated, and the neck was closed primarily. Frozen section pathology of the sternoclavicular tissue demonstrated crystal deposition.

Conclusions: Final pathology demonstrated the typical negatively birefringent crystals of gout in the background of tophus, and rheumatology was consulted. The patient was placed on urate-lowering therapy and improved. She will be followed with regular uric acid levels. This is the first-ever reported case of autoimmune gout presenting as a neck abscess, though laryngeal and auricular manifestations are more common. Given gout originates in joints, it is prudent to obtain early thoracic consultation. Further studies are warranted to define head and neck treatment algorithms with respect to this rare manifestation of gout.