Introduction: The carpal tunnel syndrome (CTS) is the most common of the entrapment neuropathies in which the body´s peripheral nerves are compressed. It is caused by excessive pressure on the median nerve. Gouty tophi is a rare cause of CTS, with an incidence of 0.6%. Gouty may lead to CTS due to: synovial hypertrophy, tenosynovitis, tophaceous nodules and crystal deposits in nerves, muscles or tendons. Case report: 80 years old male with a history of a mass in the wrist of the right hand, of 5 years of evolution, which 2 years prior intervention debuts with carpal tunnel syndrome, treated with surgical removal of the mass, with preservation of flexor tendons and medial nerve. Histopathological reported xanthogranulomatous reaction foreign body type and tophaceous gout, 2 years after treatment with good evolution and no symptom recurrence. Discussion: Gout it’s a type of crystal- induced arthritis. Sodium urate crystals with localized inflammation and neutrophil activation that further activate macrophages forming an inflammatory loop. Gout is an uncommon cause of carpal tunnel syndrome. One of the firsts reported cases dated to 1966 by Phalen et al. reported 15 hands with gout in 2469 cases of carpel tunnel syndrome (0.6%). Patil el al. reported three cases of gout among 3216 cases of carpal syndrome (0.9%). Surgical treatment is considered effective for chronic patients. Conclusions: Gouty tophus is a rare cause of carpal tunnel syndrome; an early diagnosis and control of the gout are necessary to avoid irreversible nerve injury. Delays in the diagnosis and treatment can lead to functional damage and residual deformity. Surgical treatment combined with medical treatment can improve the treatment outcome of gouty tophus. Key words: Tophaceus gout, median nerve, carpal tunnel syndrome, hand surgery.