Elsevier

The Spine Journal

Volume 7, Issue 1, January–February 2007, Pages 94-99
The Spine Journal

Case Study
Tophaceous gout of the lumbar spine mimicking pyogenic discitis

https://doi.org/10.1016/j.spinee.2006.01.009Get rights and content

Abstract

Background context

Gout of the spine is very rare. Forty-one cases of gout affecting the spine have been reported.

Purpose

To present a patient with tophaceous gout of the lumbar spine mimicking pyogenic discitis.

Study design

Case report.

Methods

The medical record, including operative notes, progress notes, discharge summary, clinical notes, radiological study, and pathological studies was reviewed.

Results

The patient had acute low back pain and radiculopathy with high spiking fever. Therefore, pyogenic discitis was suspected. However, histological diagnosis revealed tophaceous gout.

Conclusions

Tophaceous gout of the spine is very rare. However, when a patient presents with acute back pain and fever, spinal gout should be considered, particularly in a patient with a previous history of hyperuricemia or gout.

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.

References (8)

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