Uricular tophi are not common and may resemble a number of other diseases including squamous cell carcinomas, Kaposi’s sarcoma, epidermal and dermoid cysts, rheumatoid nodules. Biopsy should be performed to rule out malignancy. Conclusions: Tophi of the auricle are usually asymptomatic but can become inflamed and occasionally ulcerate through the overlying skin. Chronic tophaceous gout is treated with dietary control and medication. Surgical excision is performed under local anesthetic if symptoms progression or cosmetically deformity is concerned. Keywords: Tophus, AuricleBackground Auricular tophi are firm deposits of monosodium urate in crystal form, which may slowly develop in subcutaneous tissue. Gout tophi occurs around auricular area is not common. Common locations for this growth on the ear are the helix and the antihelix. We present PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/27741243 a 64-year-old man who had multiple painless nodules over bilateral helix after he received anti-tuberculosis therapy. Auricular tophi are not common and may resemble a number of other diseases including squamous cell carcinomas, Kaposi’s sarcoma, epidermal and dermoid cysts, rheumatoid nodules. Biopsy should be performed to rule out malignancy. Case presentation A 64-year-old man was seen with a 6-month history of multiple bilateral auricular nodules. He also had a history of pulmonary tuberculosis and had been receiving antituberculosis therapy since December 2009. The protocol consisted of 4 drugs (isoniazid, rifampin, pyrazinamide, and ethambutol hydrochloride) administered for 2 months, followed by 4 months of treatment with* Correspondence: [email protected] 4 Department of Pathology, Cathay General Hospital, Taipei, Taiwan Full list of author information is available at the end of the articleisoniazid and rifampin. He denied any history of trauma or sun exposure. Physical examination revealed multiple 2.5-mm painless nodules over the helix (Figure 1). These were superficial, circumscribed, and without surrounding erythema or ulceration. An excisional biopsy was performed. The lesion was separated easily from the surrounding tissues and did not invade the perichondrium. Hematoxylin-eosin staining of biopsy specimens revealed amorphous BLU-554 biological activity fibrillary crystalline tissue deposits in formalin-fixed tissue, representing a proteinaceous matrix that surrounded dissolved crystals, consistent with gout tophi (Figure 2). The differential diagnosis of auricular nodules is broad and includes sebaceous cysts, chondrodermatitis nodularis helicis, sarcoid nodules, leprosy, hemangioma, keratoacanthoma, chondroma, lipoma, squamous cell carcinomas, Kaposi’s sarcoma, melanoma, epidermal and dermoid cysts, elastotic nodules, tophaceous gout, rheumatoid nodules, and schwannoma [1]. Biopsy should be performed to rule out malignancy. Gout is a common systemic metabolic disease, but manifestations of it are infrequently encountered in the field of otolaryngology. It is caused by disordered purine metabolism, resulting in hyperuricemia. When the uric?2013 Chang et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Chang et al. BMC Research Notes 2013, 6:480 http://www.biomedcentral.com/1756-0500/6/Page 2 ofFigure 2 Hematoxylin-eosin staining of the excised lesion. The disso.