Medial Canthal Gouty Tophus: A Report of a Rare Case

Subcutaneous collections of monosodium urate crystals, known as gouty tophi, usually develop in joints and distal parts of the limbs. Their appearance around the eye is very uncommon. We present the case of a 38-year-old Malay gentleman with a nine-year history of poorly controlled gout who developed a progressively enlarging, painless mass at the right medial canthus. Serum uric acid was 727 μmol/L (reference range: 200-420 μmol/L). Clinical examination revealed a 5 × 5 mm yellowish, nodular, nonmobile, nontender mass. Excision biopsy was performed, and histopathology showed an intradermal aggregate of acellular eosinophilic material rimmed by multinucleated giant cells, histiocytes, and lymphoplasmacytic cells, findings diagnostic of a gouty tophus. Postoperative recovery was uneventful. This case represents the first reported medial canthal gouty tophus in Malaysia. Gouty tophus should be considered in the differential diagnosis of periocular masses, especially in patients with chronic gout and hyperuricemia.