# Neck swelling in a patient with gout - What is the cause?

## TL;DR

A patient with gout had unusual neck swelling caused by urate crystal deposits, highlighting diagnostic challenges.

## Contribution

Demonstrates a rare gout manifestation at the sternoclavicular joint with diagnostic implications.

## Key findings

- Tophaceous gout can present as bilateral soft tissue lesions in joints.
- Lytic bone lesions with cortical destruction were observed in clavicles and manubrium.
- Monosodium urate crystals confirmed via synovial fluid analysis.

## Abstract

We describe the case of a 55-year-old man with underlying tophaceous gout who presented with a 6-month history of multiple joint pains and associated constitutional symptoms. Physical examination revealed firm and non-tender swelling measuring 3x4 cm adjacent to the left clavicular head. This swelling did not move with deglutition. Neck imaging showed bilateral heterogeneous soft tissue lesions at the sternoclavicular, first costochondral and acromioclavicular joints. Multiple lytic lesions with cortical destruction involving the upper manubrium and distal ends of both clavicles were seen. Fine needle aspiration of the sternoclavicular joint yielded a small amount of synovial fluid, and its histopathological analysis confirmed the presence of monosodium urate crystal deposition. This case demonstrates a rare manifestation of tophaceous gout at the sternoclavicular joint, underscoring its ability to mimic other pathologies and the consequent challenges in diagnosis.