PMID: 11334288May 4, 2001Paper

Tophaceous gout of the spine mimicking epidural infection: case report and review of the literature

Neurosurgery
K BarrettJ T Wilson

Abstract

Tophaceous gout uncommonly affects the axial skeleton. The clinical presentations of gout of the spine range from back pain to quadriplegia. Gout that presents as back pain and fever may be difficult to distinguish from spinal infection. We present a case of a patient with tophaceous gout of the lumbar spine who was initially diagnosed with and treated for an epidural infection. The clinical and diagnostic features of tophaceous gout of the spine are reviewed. A 70-year-old man presented with a 2-day history of fever and back pain. A physical examination revealed that he had flank tenderness and evidence of polyarthritis affecting the elbows, knees, and right first metatarsophalangeal joint. A magnetic resonance imaging scan of the patient's lumbar spine showed an extensive area of abnormal gadolinium enhancement of the paramedian posterior soft tissues from L3 to S1 with an area of focal enhancement extending into the right L4-L5 facet joint. A laminectomy was performed at L4-L5, and a chalky white material in the facet joint was found eroding into the adjacent pars intra-articularis. Light and polarizing microscopy confirmed the presence of gouty tophus. No evidence of infection was found. Gouty arthritis of the spine is rare...Continue Reading

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Citations

Aug 31, 2006·The British Journal of Radiology·D Butteriss, C Soh
Feb 12, 2009·The Journal of Rheumatology·Rukmini M KonatalapalliArthur Weinstein
Feb 10, 2012·Current Rheumatology Reports·Elena LumezanuArthur Weinstein
May 1, 2002·Current Opinion in Rheumatology·Robert L Wortmann
Jul 5, 2011·The Journal of Rheumatology·Ethan LevinRichard Brasington
Feb 2, 2012·Internal Medicine·Shigeru Kotake, Yuki Nanke
Mar 1, 2012·Clinical Rheumatology·Francesco BolzettaGiuseppe Sergi
Jun 17, 2010·Age and Ageing·Daniel James MurphyRichard Clive Haigh
Oct 23, 2015·Current Rheumatology Reports·Michael ToproverMichael H Pillinger
Jan 13, 2015·Case Reports in Rheumatology·Eduardo Araújo Santana NunesMittermayer Santiago
May 4, 2007·Journal of the Chinese Medical Association : JCMA·Yi-Jie KuoYang-Hwei Tsuang
Nov 23, 2006·AJR. American Journal of Roentgenology·Jason OaksJames K Metcalfe
May 23, 2006·The British Journal of Radiology·A C PankhaniaD Du Plessis
Jan 11, 2007·Surgical Neurology·Lewis C HouMaxwell Boakye

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