Case StudyTophaceous gout of the lumbar spine mimicking pyogenic discitis
Introduction
Gout is a metabolic disease involving the peripheral joints. Gouty arthritis of the axial joints, the spine in particular, is very rare. Only 41 cases of gout involving the spine have been reported in the literature [1], [2], [3], [4], [5], [6], [7], [8]. We present a case of gouty spondyloarthropathy which was initially suspected as pyogenic discitis.
Section snippets
Case report
A 55-year-old male patient had severe low back pain and radiating pain to both lower extremities that lasted for a week. He had a history of being an alcoholic who drank one bottle of Soju (Korean vodka) every day. During the past 7 days he did not eat any meals, but only drank alcohol to relieve severe low back pain. Physical examination revealed a fever of 40°C. There were erythematous changes and local heat on his left ankle. On the straight leg raising test, the right leg was raised 10
Discussion
Gout of the axial skeleton is an unusual manifestation of tophaceous gout. A recent review found 37 reported cases [1], and we found five additional cases [2], [3], [4], [5] including the one in the current study. These patients were predominantly men and ranged in age from 33 to 76 years. In 28 of the 42 reported cases, the patients had a previous history of gout, and 21 of the 42 patients experienced severe polyarticular gout. Cervical, thoracic, and lumbosacral spine involvement have all
Conclusion
Tophaceous gout of the spine is very rare. However, when a patient presents acute back pain and fever, spinal gout should be considered, particularly in a patient with a previous history of hyperuricemia or gout.
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Cited by (42)
Axial calcium pyrophosphate dihydrate deposition disease revealed by recurrent sterile spondylodiscitis with epidural abscess
2014, Revue du Rhumatisme (Edition Francaise)Axial calcium pyrophosphate dihydrate deposition disease revealed by recurrent sterile spondylodiscitis and epidural abscess
2014, Joint Bone SpineCitation Excerpt :Axial CPDD could mimic septic spondylodiscitis and aseptic abscess. This rare manifestation has been reported in axial gout [1,2,6–9]. The diagnosis of axial CPDD should be systematically considered in the case of acute inflammatory back pain occurring in the elderly, especially if there is a history of peripheral articular CPDD.
Spinal gout: Five cases, including two developing cases of gout
2014, Revue du Rhumatisme (Edition Francaise)When gout involves the spine: Five patients including two inaugural cases
2013, Joint Bone SpineCitation Excerpt :Some patients have little or no symptoms, and the diagnosis is established only when an imaging study shows abnormalities, particularly a spinal tophus [6] (as in our patient #2). Others present with severe symptoms such as inflammatory pain suggesting discitis [14–16] (as in our patients #3 and #4), epidural infection [17], or a paraspinal abscess [18]. Spinal instability due to gouty lesions has been reported more rarely [13,19].
The Broad Spectrum of Urate Crystal Deposition: Unusual Presentations of Gouty Tophi
2012, Seminars in Arthritis and RheumatismCitation Excerpt :Gout can deposit in unusual sites and mimic tumors with reports including deposits in the skin and muscles simulating soft tissue tumors, hyperkeratotic periungual lesions, and laryngeal deposits appearing as squamous cell carcinoma, tophi imitating intra-articular synovial tumors of the knee, intraosseous gout seeming to be bone tumors, spinal gout looking like metastatic disease, and internal organ involvement appearing to be malignancies of the pancreas and colon (15,50,51,101-105). Gout can mimic infection and reports of gouty flexor tenosynovitis looking like tuberculous and other infectious tenosynovitis, tophaceous gout of the spine simulating pyogenic discitis, osteomyelitis, and epidural infection, gouty panniculitis appearing as infectious cellulitis, and valvular tophi suggestive of infectious endocarditis exist in the literature (41,82,83,106-109). Cases of gout causing ruptured popliteal cysts simulating thrombophlebitis have also been reported (110-112).
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