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Qing P, Xie S, Feng C, Xu H, Zhao S, Zhang L, Deng H, Wang Y, Hu Y. Case Report: Intradural gout tophi without systemic gout symptoms. Front Surg 2025; 12:1472886. [PMID: 39996153 PMCID: PMC11847885 DOI: 10.3389/fsurg.2025.1472886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 01/10/2025] [Indexed: 02/26/2025] Open
Abstract
Background Gout is a common disease; however, a gout tophus occurring within the spinal dura is exceedingly rare, with only two cases reported to date. Case presentation We report the case of a 70-year-old female who presented with lower back pain, right radicular pain, and numbness in the perineal area. Magnetic resonance imaging and computed tomography scans revealed a calcified intradural lesion at the L3 level. The diagnosis of the lesion was not definitive because the patient had no history of gout or manifestations of systemic gout. Surgical removal of the intradural lesion followed by pathological examination confirmed gouty tophi. The postoperative recovery was good, and the patient experienced substantial relief from pain and numbness. Conclusion This is the third documented case of gout tophi occurring within the spinal dura. In a literature review, it was found that none of these three patients with intradural gouty tophi had systemic gout manifestations or hyperuricemia, which is a crucial finding. As it is challenging to diagnose intradural gout, awareness among physicians must be increased to optimize the treatment of, and outcomes for, these patients.
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Affiliation(s)
| | - Shiming Xie
- Mianyang Orthopedic Hospital, Mianyang, China
| | - Chaoqun Feng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongda Xu
- Mianyang Orthopedic Hospital, Mianyang, China
| | | | - Lei Zhang
- Mianyang Orthopedic Hospital, Mianyang, China
| | - Haitao Deng
- Mianyang Orthopedic Hospital, Mianyang, China
| | - Yehui Wang
- Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Youpeng Hu
- Mianyang Orthopedic Hospital, Mianyang, China
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2
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Wang Y, Zha Y, Liu L, Liao A, Dong Z, Roberts N, Li Y. Single photon emission computed tomography/computed tomography imaging of gouty arthritis: A new voice. J Transl Int Med 2024; 12:215-224. [PMID: 39081275 PMCID: PMC11284626 DOI: 10.2478/jtim-2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Gouty arthritis, often referred to simply as gout, is a disorder of purine metabolism characterized by the deposition of monosodium urate monohydrate (MSU) crystals in multiple systems and organs, especially in joints and their surrounding soft tissue. Gout is a treatable chronic disease, and the main strategy for effective management is to reverse the deposition of MSU crystals by uric acid reduction, and to prevent gout attacks, tophi deposition and complications, and thereby improve the quality of life. However, the frequent association of gout with other conditions such as hypertension, obesity, cardiovascular disease, diabetes, dyslipidemia, chronic kidney disease (CKD) and kidney stones can complicate the treatment of gout and lead to premature death. Here, we review the use of medical imaging techniques for studying gouty arthritis with special interest in the potential role of single photon emission computed tomography (SPECT)/computed tomography (CT) in the clinical management of gout and complications (e.g., chronic kidney disease and cardiovascular disease).
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Affiliation(s)
- Yan Wang
- Department of Nuclear Medicine, Guizhou Provincial People's Hospital, Affiliated Hospital of Guizhou University, Guiyang 550002, Guizhou Province, China
| | - Yan Zha
- Department of Nuclear Medicine, Guizhou Provincial People's Hospital, Affiliated Hospital of Guizhou University, Guiyang 550002, Guizhou Province, China
- Departnent of Nephrology, Guizhou Provincial People's Hospital, Affiliated Hospital of Guizhou University, Guiyang 550002, Guizhou Province, China
| | - Lin Liu
- Department of Nuclear Medicine, Guizhou Provincial People's Hospital, Affiliated Hospital of Guizhou University, Guiyang 550002, Guizhou Province, China
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Affiliated Hospital of Guizhou University, Guiyang 550002, Guizhou Province, China
| | - Ang Liao
- Department of Nuclear Medicine, Guizhou Provincial People's Hospital, Affiliated Hospital of Guizhou University, Guiyang 550002, Guizhou Province, China
| | - Ziqiang Dong
- Department of Nuclear Medicine, Guizhou Provincial People's Hospital, Affiliated Hospital of Guizhou University, Guiyang 550002, Guizhou Province, China
| | - Neil Roberts
- School of Clinical Sciences, The Queen’s Medical Research Institute, University of Edinburgh, EdinburghEH8 9YL , United Kingdom
| | - Yaying Li
- Department of Nuclear Medicine, Guizhou Provincial People's Hospital, Affiliated Hospital of Guizhou University, Guiyang 550002, Guizhou Province, China
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3
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Harlianto NI, Harlianto ZN. Patient characteristics, surgical treatment, and outcomes in spinal gout: a systematic review of 315 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3697-3703. [PMID: 37707602 DOI: 10.1007/s00586-023-07942-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/03/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE To systematically investigate all published literature on spinal gout regarding location demographics, patient characteristics, treatment, and outcomes. METHODS We performed a systematic literature search of Medline and EMBASE from inception until April 15, 2023. Two investigators performed data extraction and quality assessment of location demographics and patient characteristics and outcomes of all article types describing spinal gout. RESULTS A total of 214 articles (204 case reports and 10 case series) were included, encompassing 315 subjects with spinal gout (81% male, mean age 58.1 years; range: 16-92). Most cases (36%) were between the age of 60-69 years. We observed an increase in publications and cases from 1950 to the present. Most patients were from institutions in Asia (n = 119, 37.8%) and North America (n = 96, 30.5%). Reported symptoms frequently included back pain (75%), radiating pain to extremities (27.3%), and weakness in the extremities (26.3%). The lumbar spine was most often affected. Pharmacological treatment was described for 108 (34.2%) patients. Surgery was performed for 146 (46.3%) of patients, of which 4.8% had postoperative complications. Three patients (2%) required secondary surgery for recurrence. CONCLUSION Published cases of spinal gout have increased over the last decades. Patient characteristics of spinal gout were similar to findings in systemic gout. Trends identified in patient characteristics and treatment outcomes may help guide patient management and improve our understanding of spinal gout.
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Affiliation(s)
- Netanja I Harlianto
- Department of Orthopedic Surgery, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
- Department of Radiology, University Medical Center Utrecht & Utrecht University, Utrecht, The Netherlands.
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Zhou MMX, Wu MMM, Sang MML, Wu MMJ. Clinical observation of posterior decompression, fusion and fixation in the treatment of spinal gout: a case series. J Orthop Surg Res 2023; 18:303. [PMID: 37061710 PMCID: PMC10105939 DOI: 10.1186/s13018-023-03791-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023] Open
Abstract
OBJECTIVE The aim of the present study was to assess the effect of posterior decompression, fusion and fixation in the treatment of spinal gout. Spinal gout is a disease of gouty arthritis involving the spine, which can affect all segments of the spine. At present, the etiology and pathogenesis of spinal gout are not clear, and there are no definite methods for the treatment of spinal gout. METHODS This was a case series of seven patients (seven men) who underwent posterior decompression, fusion and fixation in the treatment of spinal gout between January 2016 and January 2020. Physical examination, radiography, CT, MRI, Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were used to evaluate the effect of this procedure. All patients were followed up every 3 months. The evaluation time point was 12 months after the operation. Comparisons of the functional indexes of the patients before and after the operation were performed using SPSS 22.0 (IBM, Armonk, NY, USA). RESULTS The JOA score was 13.43 ± 6.55 and the VAS score was 7.43 ± 1.51 preoperatively. The JOA score was 24.43 ± 3.74 and the VAS score was 0.86 ± 0.90 postoperatively at 12 months after surgery. At 12 months after surgery, the JOA and VAS score showed significant improvements when compared with those before surgery (P = 0.004 and P = 0.002, respectively). None of the patients had re-surgery of the gout due to actively and reasonably controlling uric acid. No loosening or displacement of screws was reported. There was only one screw tail cap loosening. Radiographic examination revealed that there was no obvious accumulation of gout or surrounding bone destruction, and the segmental instability was significantly improved. There was no progressive aggravation of neurological symptoms of the seven patients. CONCLUSIONS Posterior approach decompression, fusion and fixation can stabilize the vertebral body, remove gout and directly relieve local spinal cord compression. The method is a reliable surgical choice for the treatment of spinal gout.
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Affiliation(s)
- M M Xingmao Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan City, 528400, Guangdong Province, People's Republic of China
| | - M M Minhua Wu
- Department of Orthopaedic Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan City, 528400, Guangdong Province, People's Republic of China
| | - M M Lili Sang
- Department of Orthopaedic Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan City, 528400, Guangdong Province, People's Republic of China.
- Division of Spine Surgery, Department of Orthopaedic Surgery, Zhongshan Hospital of Traditional Chinese Medicine, No. 3, Kangxin Road, West District, Zhongshan City, 528400, Guangdong Province, People's Republic of China.
| | - M M Junzhe Wu
- Department of Orthopaedic Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan City, 528400, Guangdong Province, People's Republic of China
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Li W, Feng H. Lumbar spondylolisthesis complicated with gouty arthritis: A case report. Asian J Surg 2022:S1015-9584(22)01725-0. [DOI: 10.1016/j.asjsur.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
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Wang K, Yang QZ, Wen HN, Hai YX, Gao GD, Song M. Nerve root compression due to lumbar spinal canal tophi: A case report and review of the literature. Medicine (Baltimore) 2022; 101:e31562. [PMID: 36397389 PMCID: PMC9666167 DOI: 10.1097/md.0000000000031562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
RATIONALE Gout in the spine and adnexa is rare in clinical practice and can also be easily misdiagnosed, we reported a patient with nerve root compression due to lumbar gout stones in the lumbar spinal canal. PATIENT CONCERNS A 51-year-old male was admitted to the hospital with lumbar pain with numbness in the left lower limb for more than 6 months. The physical examination showed that tenderness and percussion pain were present at L4-S1 spinous process. Straight leg raise test: 50° on the left side were positive. Laboratory tests showed that the sUA was 669 μmol/L, MRI of the lumbar spine showed that cystic T1WI low signal and T2WI mixed high signal shadows were seen in the spinal canal at the level of L4-L5. DIAGNOSES Combining with lab examinations, imaging examinations, and histopathological results, the patient was diagnosed with lumbar spinal canal tophi. INTERVENTIONS After active improvement of all examinations, the patient underwent surgical treatment with decompression and internal fixation of the L4-L5 segment. OUTCOMES After surgery, the patient's symptoms improved and muscle strength returned to normal. Among the 95 previously reported patients with lumbar gout, the ratio of men to women was 2.96:1, and the peak age group of incidence was 56 to 65 years. The onset of the disease was mainly in a single segment of the lumbar spine, with 34.41% of all cases occurring at the L4-L5 level. 61.05% of the patients had a history of gout attacks or hyperuricemia, and the most frequently involved site was the foot and ankle, followed by the wrist. Sixty-seven patients underwent surgical treatment, and 22 chose conservative treatment, with overall satisfactory results. LESSONS SUBSECTIONS The incidence of lumbar gout is low and relatively rare in the clinic and pathological biopsy is still the gold standard. Vertebral plate incision and decompression are often selected for surgical treatment, and whether to perform fusion should be comprehensively considered for the destruction of vertebral bone by gout and the reasonable selection of the extent of surgical resection. Whether choosing surgical treatment or conservative therapy, the control of uric acid levels should be emphasized.
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Affiliation(s)
- Kai Wang
- Clinical College of Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China
| | - Quan-Zeng Yang
- Department of Orthopedics, The Affiliated hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China
| | - Hao-Nan Wen
- Clinical College of Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China
| | - Yun-Xaing Hai
- Clinical College of Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China
| | - Guo-Dong Gao
- Department of Orthopedics, The Affiliated hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China
- *Correspondence: Min Song, Clinical College of Chinese Medicine, Gansu University of Chinese Medicine,Lanzhou, Gansu Province, China (e-mail: )
| | - Min Song
- Clinical College of Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China
- Department of Orthopedics, The Affiliated hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China
- *Correspondence: Min Song, Clinical College of Chinese Medicine, Gansu University of Chinese Medicine,Lanzhou, Gansu Province, China (e-mail: )
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Wu Z, Liu C, Dai K, Zheng C. Intraspinal extradural gout tophus in the lumbar vertebral canal: Case reports. Medicine (Baltimore) 2022; 101:e28418. [PMID: 35029886 PMCID: PMC8735772 DOI: 10.1097/md.0000000000028418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Intraspinal gout tophus in the lumbar vertebral canal associated with gouty arthritis is rare. We present 2 cases with the first manifestations of a sequestrated intervertebral disc and an extradural tumor, and histopathologically proven to be gouty deposits in the lumbar vertebral canal. PATIENT CONCERNS The 2 patients presented with typical radiculopathy symptoms and a positive straight leg raise. In 1 case, there was weakness of the left toe extensors, with a positive left femoral nerve traction test. Additionally, the left patellar tendon reflex was weak. In the other patient who was unable to walk, there was a sensory deficit in the saddle distribution. DIAGNOSIS Histopathological examination of the specimens taken from the operation confirmed the presence of gouty deposits. INTERVENTIONS Posterior decompression was performed in these 2 cases, and chalky-white materials were identified in the lumbar vertebral canal. OUTCOMES No evidence of neoplasm, infection, or synovial cyst was found. LESSONS Definitive diagnosis of intraspinal extradural gout tophus, mimicking a sequestrated intervertebral disc or an extradural tumor, may be difficult. The initial suspicion of intraspinal gouty deposits, based on the diagnostic/management algorithm, may effectively avoid incorrect diagnosis via a less invasive procedure than explorative laminectomy.
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8
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Boudabbous S, Paulin EN, Delattre BMA, Hamard M, Vargas MI. Spinal disorders mimicking infection. Insights Imaging 2021; 12:176. [PMID: 34862958 PMCID: PMC8643376 DOI: 10.1186/s13244-021-01103-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/03/2021] [Indexed: 12/23/2022] Open
Abstract
Spinal infections are very commonly encountered by radiologists in their routine clinical practice. In case of typical MRI features, the diagnosis is relatively easy to interpret, all the more so if the clinical and laboratory findings are in agreement with the radiological findings. In many cases, the radiologist is able to make the right diagnosis, thereby avoiding a disco-vertebral biopsy, which is technically challenging and associated with a risk of negative results. However, several diseases mimic similar patterns, such as degenerative changes (Modic) and crystal-induced discopathy. Differentiation between these diagnoses relies on imaging changes in endplate contours as well as in disc signal. This review sought to illustrate the imaging pattern of spinal diseases mimicking an infection and to define characteristic MRI and CT patterns allowing to distinguish between these different disco-vertebral disorders. The contribution of advanced techniques, such as DWI and dual-energy CT (DECT) is also discussed.
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Affiliation(s)
- Sana Boudabbous
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. .,Faculty of Medicine of the Geneva University, Geneva, Switzerland.
| | - Emilie Nicodème Paulin
- Division of Radiology, Medical Imaging Department, Hospital of Neuchatel, Neuchâtel, Switzerland
| | - Bénédicte Marie Anne Delattre
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Faculty of Medicine of the Geneva University, Geneva, Switzerland
| | - Marion Hamard
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Maria Isabel Vargas
- Faculty of Medicine of the Geneva University, Geneva, Switzerland.,Division of Neuroradiology, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
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Romero AB, Johnson EP, Kirkpatrick JS. Tophaceous gout of the atlantoaxial joint: a case report. J Med Case Rep 2021; 15:74. [PMID: 33588945 PMCID: PMC7885401 DOI: 10.1186/s13256-020-02638-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background To report the occurrence of tophaceous gout in the cervical spine and to review the literature on spinal gout. Case presentation This report details the occurrence of a large and clinically significant finding of tophaceous gout in the atlantoaxial joint of the cervical spine in an 82-year-old Caucasian man with a 40-year history of crystal-proven gout and a 3-month history of new-onset progressive myelopathy. The patient's American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria score was 15.0. Conclusion Spinal gout is more common than previously thought, and it should be considered in patients who present with symptoms of myelopathy. Diagnosis can be made without a tissue sample of the affected joint(s) with tools like the ACR/EULAR criteria and the use of the “diagnostic clinical rule” for determining the likelihood of gout. Early conservative management with neck immobilization and medical management can avoid the need for surgical intervention.
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Affiliation(s)
- Andrew Benjamin Romero
- Department of Orthopaedic Surgery, Orlando VA Medical Center, Orlando, FL, 32827, USA. .,University of Central Florida College of Medicine, 13025 Cordelia Lane, Apt 301, Orlando, FL, 32824, USA.
| | - Evan Paul Johnson
- University of Central Florida College of Medicine, 13025 Cordelia Lane, Apt 301, Orlando, FL, 32824, USA
| | - John S Kirkpatrick
- Department of Orthopaedic Surgery, Orlando VA Medical Center, Orlando, FL, 32827, USA.,University of Central Florida College of Medicine, 13025 Cordelia Lane, Apt 301, Orlando, FL, 32824, USA
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Mishra R, Panigrahi VP, Adsul N, Jain S, Chahal RS, Kalra KL, Acharya S. Tophaceous gout in thoracic spine mimicking meningioma: A case report and literature review. Surg Neurol Int 2020; 11:364. [PMID: 33194297 PMCID: PMC7656021 DOI: 10.25259/sni_515_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/24/2020] [Indexed: 02/01/2023] Open
Abstract
Background: Gout is a common metabolic disorder of purine metabolism, causing arthritis in the distal joints of the appendicular skeleton. Spine involvement is rare, and very few cases of spinal gout have been reported. The authors present a rare case of axial gout with tophaceous deposits in the thoracic spinal canal resulting in cord compression and mimicking a meningioma. Case Description: A 33-year-old male presented with chronic mid back pain and a progressive paraparesis. The presumed diagnosis was meningioma based on MR imaging with/without contrast that showed a posterolateral, right-sided, and T10-T11 intradural extramedullary lesion. Notable, was hyperuricemia found on hematological studies. The patient underwent a decompressive laminectomy (T9-T11) for excision of the lesion, intraoperatively, an intraspinal, chalky, white mass firmly adherent to and compressing the dural sac was removed. The histopathology confirmed the diagnosis of a gouty tophus. Postoperatively, the patient’s pain resolved, and he regained the ability to walk. Conclusion: A gouty tophus should be included among the differential diagnostic considerations when patients with known hyperuricemia present with back pain, and paraparesis attributed to an MR documented compressive spinal lesion.
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Affiliation(s)
- Ratish Mishra
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Nitin Adsul
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sunila Jain
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
| | - R S Chahal
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - K L Kalra
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Shankar Acharya
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Kao Y, Wang Z, Leng J, Qu Z, Zhuang X, Ma H, Song Q, Liu Z, Sun S, Liu Y. Thoracic gout tophus with abdominal wall protrusion: A case report. Medicine (Baltimore) 2020; 99:e19348. [PMID: 32150074 PMCID: PMC7478684 DOI: 10.1097/md.0000000000019348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE A patient presented the abdominal wall protrusion due to tophaceous gout of the spine. Similar cases were not reported in the literature. This study aimed to report a case of tophaceous gout of the spine with abdominal wall protrusion. PATIENT CONCERNS A 38-year-old male patient had a 10-year history of gout and hyperuricemia. He complained of back pain and abdominal wall protrusion. DIAGNOSES The patient was diagnosed with tophaceous gout of the spine with abdominal wall weakness caused by T11 nerve root compression. INTERVENTIONS A semi-lamina decompression was performed at T11-T12. The pathological examination of the specimen demonstrated tophaceous gout of the spine. OUTCOMES After the surgery, the patient's back pain was completely relieved and the abdominal wall weakness significant improved. LESSONS This case highlighted that axial gout could mimic thoracic disk herniation clinically. The abdominal wall weakness might also be due to single T11 nerve compression by the tophaceous gout of the spine. In patients with a history of gout, axial gout should be considered as one of the differential diagnoses.
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Affiliation(s)
| | | | - Jiali Leng
- Department of Hospice, the First Hospital of Jilin University, No. 1, Xinmin St, Chaoyang District, ChangChun City, Jilin Province
| | | | | | - Hongyun Ma
- Department of Orthopaedics, Qinghai Provincial People's Hospital, Xining City, Qinghai Province
| | | | - Zijing Liu
- Nursing platform of spinal surgery department, the First Hospital of Jilin University, No. 1, Xinmin St, Chaoyang District, ChangChun City, Jilin Province, People's Republic of China
| | | | - Yi Liu
- Department of Spinal Surgery
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12
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Wan SA, Teh CL, Jobli AT, Cheong YK, Chin WV, Tan BB. A rare cause of back pain and radiculopathy - spinal tophi: a case report. J Med Case Rep 2019; 13:8. [PMID: 30626451 PMCID: PMC6325858 DOI: 10.1186/s13256-018-1940-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 12/04/2018] [Indexed: 02/08/2023] Open
Abstract
Background Gout is a monosodium urate deposition disease which is prevalent worldwide. The usual manifestations are crystal arthropathy and tophi deposition in the soft tissues. Spinal tophi may also occur and are rarely reported, resulting in various clinical manifestations such as back pain, spinal cord compression, radiculopathy, and even mimicking epidural abscess and spondylodiscitis. Case presentation We report a case of a 42-year-old Chinese man with underlying gout who presented with back pain and radiculopathy. The diagnosis of spinal tophi was unsuspected and he was initially treated for epidural abscess and spondylodiscitis. He underwent a laminectomy and posterolateral fusion during which tophus material was discovered. He recovered and medications for gout were started. Conclusion Spinal tophi are rare. The diagnosis is difficult and spinal tophi may be mistaken for epidural abscess, spondylodiscitis, or neoplasm.
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Affiliation(s)
- S A Wan
- Rheumatology Unit, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - C L Teh
- Rheumatology Unit, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - A T Jobli
- Radiology Department, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Sarawak, Malaysia.
| | - Y K Cheong
- Rheumatology Unit, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - W V Chin
- Rheumatology Unit, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - B B Tan
- Orthopaedics Department, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Sarawak, Malaysia
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13
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Cheng CW, Nguyen QT, Zhou H. Tophaceous gout of the cervical and thoracic spine with concomitant epidural infection. AME Case Rep 2018; 2:35. [PMID: 30264031 DOI: 10.21037/acr.2018.07.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022]
Abstract
Tophaceous gout of the spine is an underappreciated source of back pain in patients with or without neurological decline. It has been reported to occur in the cervical, thoracic and lumbar spine. Rarely, does it occur at more than one region of the spine. Advanced imaging with magnetic resonance imaging and computed tomography are usually not helpful in differentiating between infection, malignancy and gout. Clinician should have a high suspicion of spinal gout in patients with history of gout who presents with renal insufficiency, presence of peripheral tophi on exam, with elevated serum uric acid and creatinine levels, erythrocyte sedimentation rate and C-reactive protein. Here we present a case of a 23-year-old male with history of gout and chronic renal disease with progressive weakness in his lower extremities with new urinary incontinence who was found to have spinal gout with epidural infection of both the cervical and thoracic spine. Our patient was successfully managed with surgical decompression followed by medical treatment with antibiotics and steroids.
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Affiliation(s)
- Christina W Cheng
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Quynh T Nguyen
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, Washington, USA.,Department of Radiology, Harborview Medical Center, Seattle, Washington, USA
| | - Haitao Zhou
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, Washington, USA
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Ali HI. Expert's comment concerning Grand Rounds case entitled "Tophaceous gout of the lumbar spine mimicking a spinal meningioma" by Pedro Ribeiro da Cunha Ferreira, António Judice Peliz, and Marcos Barbosa (Eur Spine J, 2016; DOI 10.1007/s00586-016-4831-7). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:820-821. [PMID: 27858235 DOI: 10.1007/s00586-016-4851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Heba Ibrahim Ali
- Radiology Department, Ain Shams University, Ramsis Street, Cairo, Egypt.
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Gago R, Vilá S, Vélez-Rivera J, Vilá LM. Severe systemic inflammatory response syndrome immediately after spinal surgery in a patient with axial gout. BMJ Case Rep 2018; 2018:bcr-2017-222474. [PMID: 29367221 DOI: 10.1136/bcr-2017-222474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
We report a 55-year-old man with gouty arthritis who developed a 3-month history of low back pain, gradual lower extremities weakness and urinary incontinence. Lumbar MRI showed an exophytic lesion at L3-L4. Immediately after spinal decompression surgery, he developed fever, disorientation, polyarthritis, acute kidney injury and leucocytosis. He was treated with multiple antimicrobial agents for presumed spinal abscess but did not improve. Multiple body site cultures were negative. Aspiration of the sacroiliac joint revealed the presence of monosodium uric acid crystals. A diagnosis of acute gout was done, and he was treated with high-dose intravenous methylprednisolone and colchicine. Within 48 hours, he had a remarkable clinical improvement. At discharge, neurological and laboratory abnormalities had resolved. Awareness of risk factors for axial gout and a high degree of suspicion are important to establish a prompt diagnosis and treatment to prevent severe complications as seen in this case.
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Affiliation(s)
- Ricardo Gago
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Salvador Vilá
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Jonathan Vélez-Rivera
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Luis M Vilá
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Wang W, Li Q, Cai L, Liu W. Lumbar spinal stenosis attributable to tophaceous gout: case report and review of the literature. Ther Clin Risk Manag 2017; 13:1287-1293. [PMID: 29033576 PMCID: PMC5628693 DOI: 10.2147/tcrm.s145906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives Tophaceous gout seldom affects the axial skeleton. Symptoms vary according to the differential localization of urate deposits and the diagnosis is often delayed. Here, we report an unusual case of lumbar spinal stenosis caused by extradural tophaceous deposits. Methods We retrospectively reviewed a case of a patient with tophaceous gout of the lumbar spine and reviewed the relevant literature. Results A 62-year-old man with a 2-year history of lower back pain and a 3-month history of lower limb radiation pain and intermittent claudication was admitted. After laboratory and imaging investigations he underwent surgical decompression and stabilization. Histological analysis of the extracted specimen confirmed that it was gouty tophus. The patient’s symptoms improved progressively after the operation. He recovered very well with no complications. Conclusion The mechanism associated with axial gout is not yet clear. Obesity, inactivity, and previous degenerative disc disease may be the risk factors for spinal tophus. The clinical symptoms are diverse according to the differential localization of urate deposits. It is not easy to diagnose this disease radiographically by routine radiological examination. Analysis of a biopsy specimen is definitely the only way to confirm diagnosis. Surgical treatment should be considered in patients with spinal gout who are experiencing neurological deterioration.
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Affiliation(s)
- Wei Wang
- Department of Orthopaedics, Pu Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Qingbo Li
- Department of Orthopaedics, Pu Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lei Cai
- Department of Orthopaedics, Pu Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Weijun Liu
- Department of Orthopaedics, Pu Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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de Albuquerque Ugoline BC, de Souza J, Ferrari FC, Ferraz-Filha ZS, Coelho GB, Saúde-Guimarães DA. The influence of seasonality on the content of goyazensolide and on anti-inflammatory and anti-hyperuricemic effects of the ethanolic extract of Lychnophora passerina (Brazilian arnica). JOURNAL OF ETHNOPHARMACOLOGY 2017; 198:444-450. [PMID: 28089739 DOI: 10.1016/j.jep.2017.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 06/06/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Lychnophora passerina (Mart ex DC) Gardn (Asteraceae), popularly known as Brazilian arnica, is used in Brazilian folk medicine to treat pain, rheumatism, bruises, inflammatory diseases and insect bites. AIM OF THE STUDY Investigate the influence of the seasons on the anti-inflammatory and anti-hyperuricemic activities of ethanolic extract of L. passerina and the ratio of the goyazensolide content, main chemical constituent of the ethanolic extract, with these activities. MATERIALS AND METHODS Ethanolic extracts of aerial parts of L. passerina were obtained from seasons: summer (ES), autumn (EA), winter (EW) and spring (EP). The sesquiterpene lactone goyazensolide, major metabolite, was quantified in ES, EA, EW and EP by a developed and validated HPLC-DAD method. The in vivo anti-hyperuricemic and anti-inflammatory effects of the ethanolic extracts from L. passerina and goyazensolide were assayed on experimental model of oxonate-induced hyperuricemia in mice, liver xanthine oxidase (XOD) inhibition and on carrageenan-induced paw edema in mice. RESULTS HPLC method using aqueous solution of acetic acid 0.01% (v/v) and acetonitrile with acetic acid 0.01% (v/v) as a mobile phase in a gradient system, with coumarin as an internal standard and DAD detection at 270nm was developed. The validation parameters showed linearity in a range within 10.0-150.0µg/ml, with intraday and interday precisions a range of 0.61-3.82. The accuracy values of intraday and interday analysis within 87.58-100.95%. EA showed the highest goyazensolide content. From the third to the sixth hour after injection of carrageenan, treatments with all extracts at the dose of 125mg/kg were able to reduce edema. Goyazensolide (10mg/kg) showed significant reduction of paw swelling from the second hour assay. This sesquiterpene lactone was more active than extracts and presented similar effect to indomethacin. Treatments with ES, EA and EP (125mg/kg) and goyazensolide (10mg/kg) reduced serum urate levels compared to hyperuricemic control group and were able to inhibit liver XOD activity. One of the mechanisms by which ES, EA, EP and goyazensolide exercise their anti-hyperuricemic effect is by the inhibition of liver XOD activity. Goyazensolide was identified as the main compound present in ES, EA, EW and EP and it is shown to be one of the chemical constituents responsible for the anti-inflammatory and anti-hyperuricemic effects of the ethanolic extracts. CONCLUSION The anti-inflammatory and anti-hyperuricemic activities of the ethanolic extracts from L. passerina were not proportionally influenced by the variation of goyazensolide content throughout the seasons. The involvement of goyazensolide on in vivo anti-inflammatory and anti-hyperuricemic activities of L.passerina extracts was confirmed, as well as the possibility of participation of other constituents on these effects. This study demonstrated that the aerial parts of L. passerina may be collected in any season for use as anti-inflammatory agent. For use in hyperuricemia, the best seasons for the collection are summer, autumn and spring. The ethanolic extract of L. passerina and goyazensolide can be considered promising agents in the therapeutic of inflammation, hyperuricemia and gout.
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Affiliation(s)
- Bruno César de Albuquerque Ugoline
- Laboratório de Plantas Medicinais (LAPLAMED), CiPharma, Escola de Farmácia, Campus da Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais 35400-000, Brazil
| | - Jacqueline de Souza
- Laboratório de Controle de Qualidade, CiPharma, Escola de Farmácia, Campus da Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais 35400-000, Brazil
| | - Fernanda Cristina Ferrari
- Laboratório de Plantas Medicinais (LAPLAMED), CiPharma, Escola de Farmácia, Campus da Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais 35400-000, Brazil
| | - Zilma Schimith Ferraz-Filha
- Laboratório de Plantas Medicinais (LAPLAMED), CiPharma, Escola de Farmácia, Campus da Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais 35400-000, Brazil; Departamento de Química, Instituto Federal de Minas Gerais-Campus Ouro Preto, Ouro Preto, Minas Gerais 35400-000, Brazil
| | - Grazielle Brandão Coelho
- Laboratório de Plantas Medicinais (LAPLAMED), CiPharma, Escola de Farmácia, Campus da Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais 35400-000, Brazil
| | - Dênia Antunes Saúde-Guimarães
- Laboratório de Plantas Medicinais (LAPLAMED), CiPharma, Escola de Farmácia, Campus da Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais 35400-000, Brazil.
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Elgafy H, Liu X, Herron J. Spinal gout: A review with case illustration. World J Orthop 2016; 7:766-775. [PMID: 27900275 PMCID: PMC5112347 DOI: 10.5312/wjo.v7.i11.766] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/01/2016] [Accepted: 08/17/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To summarize clinical presentations and treatment options of spinal gout in the literature from 2000 to 2014, and present theories for possible mechanism of spinal gout formation. METHODS The authors reviewed 68 published cases of spinal gout, which were collected by searching "spinal gout" on PubMed from 2000 to 2014. The data were analyzed for clinical features, anatomical location of spinal gout, laboratory studies, imaging studies, and treatment choices. RESULTS Of the 68 patients reviewed, the most common clinical presentation was back or neck pain in 69.1% of patients. The most common laboratory study was elevated uric acid levels in 66.2% of patients. The most common diagnostic image finding was hypointense lesion of the gout tophi on the T1-weighted magnetic resonance imaging scan. The most common surgical treatment performed was a laminectomy in 51.5% and non-surgical treatment was performed in 29.4% of patients. CONCLUSION Spinal gout most commonly present as back or neck pain with majority of reported patients with elevated uric acid. The diagnosis of spinal gout is confirmed with the presence of negatively birefringent monosodium urate crystals in tissue. Treatment for spinal gout involves medication for the reduction of uric acid level and surgery if patient symptoms failed to respond to medical treatment.
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Tophaceous gout of the lumbar spine mimicking a spinal meningioma. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 27:815-819. [PMID: 27817138 DOI: 10.1007/s00586-016-4831-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/27/2016] [Accepted: 10/16/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE Although gout is a common metabolic disorder, it usually affects distal joints of the appendicular skeleton. Axial spine involvement is rare, with only 131 cases reported in the literature. The authors report a rare case of lumbar spinal gout mimicking a spinal meningioma. METHODS A 77-year-old man with a history of gout presented with chronic low back pain and progressive paraparesis. Imaging revealed a lumbar spine compressive mass lesion with a dural tail signal. The differential diagnosis was thought to be straightforward favoring a spinal meningioma. Tophaceous gout was never considered. The presence of a dural tail associated with the lesion is an interesting detail of this case, that strongly misguided it and to the best of our knowledge it is the first one reported in the literature. RESULTS The patient underwent surgery and intra-operative findings were surprisingly different from those expected, revealing a chalky white mass lesion firmly adherent and compressing the dural sac. It was completely excised, leaving the dura intact. Histopathology confirmed the diagnosis of tophaceous gout. The patient was sent to physical therapy and had a complete remission of pain and neurological deficit, regaining his walking capacity. CONCLUSION Although spinal gout is rare, it should be considered in the differential diagnosis for patients presenting with symptoms of spinal stenosis, a suspicion of neoplastic lesion of the spine, and a previous history of gout. Early diagnosis can ensure proper and timely medical management, perhaps avoiding neurological compromise and the need for surgery.
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Abstract
Gout is characterized by the deposition of monosodium urate crystals and by acute and chronic inflammation in response to crystals so deposited. Multiple case reports and series describe the deposition of monosodium urate in the spine as a rare manifestation of gout, but the actual prevalence of spinal involvement is unknown and likely to be higher than generally anticipated. Here we review the characteristics of 131 previously reported cases of spinal involvement in gout. We focus in particular on the use of imaging modalities and the extent to which they correlate with presenting symptoms and tissue diagnoses. The recent innovation of using dual-energy computerized tomography to identify urate crystal deposition holds promise for reducing the need for surgical intervention and for establishing a true prevalence rate for spinal gout.
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Axial gout is frequently associated with the presence of current tophi, although not with spinal symptoms. Spine (Phila Pa 1976) 2014; 39:E1531-6. [PMID: 25271500 DOI: 10.1097/brs.0000000000000633] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cross-sectional study. OBJECTIVE To analyze the association of tomographically identified axial gouty lesions with clinical and laboratory characteristics. SUMMARY OF BACKGROUND DATA Axial gout might be more common than previously thought. The true relationship of these lesions to symptoms or other gout-associated features is poorly understood. METHODS Forty-two patients with gout underwent thoracic and lumbar spine computed tomographic (CT) scans. CT scans were read by an experienced radiologist blinded to the features of the patients. Axial gout was defined as the presence of bony erosions, facet joints, or disc calcification and tophi in the axial skeleton. Epidemiological and clinical data were collected from medical records. At study entry, patients were evaluated for axial symptoms (back pain or neurological complaints) and subcutaneous tophi. The Fisher exact test and the Student t test were performed for statistical analyses of data. RESULTS Twelve (29%) of the 42 patients had CT evidence of axial gout. Axial tophi were identified in 5 patients (12%), interapophyseal joints erosions or calcifications in 7 patients (17%), and discal abnormalities in 9 patients (21%). Lumbar spine involvement was a universal finding. Five patients (42%) had thoracic spine involvement and 2 patients (18%) had sacroiliac lesions. No association was found between symptoms and axial gout (P = 0.62). Duration of gout, mechanism of disease (overproduction vs. underexcretion), and metabolic comorbidities were not related to axial involvement. A higher prevalence of axial gout was found between patients with current peripheral tophi (67% vs. 30%; P = 0.03); however, no association was found in patients with a past history of tophi (P = 0.72). CONCLUSION Our study demonstrated a high prevalence of axial gout not associated with spine symptoms. This finding introduces a differential diagnosis in axial lesions in patients with gout. In addition, the unique association with a current but not previous history of peripheral tophi suggests that gout treatment might be effective in preventing or solving gout axial lesions. LEVEL OF EVIDENCE 3.
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Algahtani HA, Al-Rabia MW, Aldarmahi AA, Hammond RR, Sahjpaul RL. Cervical gouty myelopathy in two cases at King Abdulaziz Medical City. J Taibah Univ Med Sci 2014. [DOI: 10.1016/j.jtumed.2014.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hasegawa EM, de Mello FM, Goldenstein-Schainberg C, Fuller R. Gout in the spine. REVISTA BRASILEIRA DE REUMATOLOGIA 2014. [PMID: 24051913 DOI: 10.1590/s0482-50042013000300008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Axial gout can affect all segments of the spine. It is manifested as back pain, as pain associated with neurological symptoms, and as neurological impairment without pain in 17.9%, 75.8% and 4.2% of cases, respectively. These manifestations were the first presentation of gout in many patients. Although x-rays as well as computed tomography and especially magnetic resonance scans can be very suggestive, histopathological, cytological and crystal analyses are the diagnostic gold standard. In most cases involving neurological manifestations, the patient underwent surgery, leading to satisfactory results. There are, however, some reports of full recovery following the usual clinical treatment for gout, suggesting that such treatment may be the initial option for those subjects with a history of gout and radiological findings of axial involvement.
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Jegapragasan M, Calniquer A, Hwang WD, Nguyen QT, Child Z. A case of tophaceous gout in the lumbar spine: a review of the literature and treatment recommendations. EVIDENCE-BASED SPINE-CARE JOURNAL 2014; 5:52-6. [PMID: 24715872 PMCID: PMC3969431 DOI: 10.1055/s-0034-1366979] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 12/02/2013] [Indexed: 12/24/2022]
Abstract
Study Design Case report. Objective The objective of this study is to report the occurrence of tophaceous gout in the lumbar spine. Methods Using a case report to illustrate the key points of gout in the spine, we provide a brief review of gout in the literature as it relates to its orthopedic and spinal manifestations as well as guidelines for management. Results This case report details the occurrence of a large and clinically significant finding of tophaceous gout in the lumbar spine in a 24-year-old man with a known history of gout and a 3-year history of progressive back pain. Conclusion A high index of suspicion can assist in diagnosis of patients presenting with back pain or neurologic findings with a history of gout. A previous history of gout (especially the presence of tophi), hyperuricemia, and the radiological characteristics presented here should aid the clinician in making the diagnosis of spinal gout. Early diagnosis has the potential to prevent the need for surgical intervention.
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Affiliation(s)
- Mithulan Jegapragasan
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, United States
| | - Alejandro Calniquer
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, United States
| | - William D Hwang
- Department of Radiology, University of Washington, Seattle, United States
| | - Quynh T Nguyen
- Department of Radiology, University of Washington, Seattle, United States
| | - Zachary Child
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, United States
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Yoon JW, Park KB, Park H, Kang DH, Lee CH, Hwang SH, Jung JM, Han JW, Park IS. Tophaceous gout of the spine causing neural compression. KOREAN JOURNAL OF SPINE 2013; 10:185-8. [PMID: 24757485 PMCID: PMC3941767 DOI: 10.14245/kjs.2013.10.3.185] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 09/09/2013] [Accepted: 09/11/2013] [Indexed: 12/14/2022]
Abstract
Gout is a common metabolic disease in which monosodium urate crystals called tophi develop. Spinal involvement in gout resulting in neural compression is unusual. We describe a case of a 64-year-old man with a history of gouty arthritis of the knee. The patient presented with thoracic myelopathy and radiculopathy. Imaging of the spine revealed an extradural mass lesion with bony erosion of the thoracic spine. A decompressive operation was performed, and a chalky white material was found. Histopathological examination confirmed a gouty tophus. The symptoms of spinal gout vary and its radiological features are not sufficiently specific to provide a definite diagnosis. Therefore, in patients with a history of gouty arthritis who present with neural compressive symptoms of the spine, spinal gout should be strongly suspected.
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Affiliation(s)
- Jong-Won Yoon
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyung-Bum Park
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyun Park
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Dong-Ho Kang
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chul-Hee Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Soo-Hyun Hwang
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin-Myung Jung
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jong-Woo Han
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - In Sung Park
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea. ; Gyeongsang Institute of Health Science, Jinju, Korea
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Kara A, McQuillan P, Dhaliwal G. A multifaceted case. J Hosp Med 2013; 8:267-70. [PMID: 23606357 DOI: 10.1002/jhm.2043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/20/2013] [Accepted: 02/27/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Areeba Kara
- Department of Inpatient Medicine, Indiana University Health Physicians, Indianapolis, IN 46202, USA.
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Ahmad I, Tejada JG. Spinal gout: a great mimicker. A case report and literature review. Neuroradiol J 2012; 25:621-5. [PMID: 24029100 DOI: 10.1177/197140091202500518] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/14/2012] [Indexed: 01/05/2023] Open
Abstract
Spinal gout is not as rare as was previously thought and mimics heterogeneous spinal conditions such as rheumatoid, septic, seronegative arthropathies and primary or secondary neoplasms. Imaging findings are nonspecific and usually manifest late. In clinical settings, suspicious for spinal gout, needle biopsy may help for further characterization. A 57-year-old man with no significant past medical history presented in the emergency department with severe non radiating low back pain of one week duration. His laboratory tests were significant for uric acid of 642 μmol/L, erythrocyte sedimentation rate 93 mm/hour, and C-reactive protein 8.3 mg/dl. The lumbar spine MRI showed nonspecific acute inflammatory extensive lumbar facet arthropathy and soft tissue enhancement. The radiological and clinical information was insufficient to differentiate among septic arthritis, rheumatoid arthritis, seronegative arthropathy or gout. A lumbar facet fluoroscopy-fluoroscopic CT-guided needle biopsy was performed. The biopsy demonstrated negative birefringent crystals consistent with gout. Although the spinal gout is not rare, few case reports describe the role of needle biopsy and mimics. We present a comparative review of limited reports addressing the role of needle biopsy in mimics of spinal gout.
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Affiliation(s)
- I Ahmad
- Radiology Department, Indiana University School of Medicine; Indianapolis, Indiana, USA -
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Affiliation(s)
- Janine Rufener
- Department of General Internal Medicine, University Hospital Bern and University of Bern, Switzerland
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Sakamoto FA, Winalski CS, Rodrigues LCL, Fernandes ARC, Bortoletto A, Sundaram M. Radiologic case study. Orthopedics 2012; 35:353-437. [PMID: 22588390 DOI: 10.3928/01477447-20120426-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Flávia A Sakamoto
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave A21, Cleveland, OH 44195, USA.
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The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi. Semin Arthritis Rheum 2012; 42:146-54. [PMID: 22522111 DOI: 10.1016/j.semarthrit.2012.03.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/07/2012] [Accepted: 03/18/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Gout is typically described as an inflammatory arthropathy that affects the peripheral joints. Our aim was to describe atypical and rare clinical presentations of gouty tophi to help increase physician awareness and aid in patient care. METHODS The relevant English literature of unusual gout manifestations was searched using the keywords gout, toph*, monosodium urate, uric acid, unusual, and rare. Well-described case reports, case series, and review articles were evaluated and included, if relevant, in the literature review. RESULTS Review of the literature revealed many unusual manifestations of gouty tophi involving the head and neck, skin, viscera, bones, tendons, ligaments, nerves, and axial skeleton. Transplant recipients, women, and elderly people are particularly susceptible to developing tophi. Furthermore, gout can cause diagnostic dilemmas, as it can be a great mimicker of and can coexist with infection, malignancy, and other connective tissue diseases. Imaging modalities can help detect tophi in atypical locations. CONCLUSIONS Tophi can present in unexpected locations, even as the first sign of gout, and vigilance is required when unusual symptoms or signs occur in a patient with gout.
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MRI of spinal bone marrow: part 2, T1-weighted imaging-based differential diagnosis. AJR Am J Roentgenol 2012; 197:1309-21. [PMID: 22109284 DOI: 10.2214/ajr.11.7420] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this article is to review the structure of bone marrow and the differential diagnosis of bone marrow pathology on the basis of T1-weighted MRI patterns. CONCLUSION Bone marrow is an organ that is evaluated routinely during MRI of the spine, particularly lumbar spine evaluation. Thus, it is one of the most commonly performed MRI examinations. T1-weighted MRI is a fundamental sequence in evaluating spinal marrow, and an understanding of T1-weighted MR signal abnormalities is important for the practicing radiologist.
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Udayakumar D, Kteleh T, Alfata S, Bali T, Joseph A. Spinal gout mimicking paraspinal abscess: A case report. J Radiol Case Rep 2010; 4:15-20. [PMID: 22470736 DOI: 10.3941/jrcr.v4i6.332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Gout is usually thought of as a peripheral joint disease. However, case reports are available describing gouty lesions in the spine. We report a case of a 51 year old African American woman with no previous history of gout who presented with lower back pain and fever and was found to have multiple small fluid collections in the paraspinal muscles at the L3 to L5 levels on the MRI. She was empirically treated with antibiotics, since the fluid was not accessible for drainage initially. Unsuccessful antibiotic therapy and an episode of peripheral gout during this hospitalization prompted the diagnosis of axial gout as the cause for the paraspinal lesions in this patient. CT guided aspiration of the paraspinal lesions confirmed monosodium urate (gout) crystals under polarized microscopy.
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Affiliation(s)
- Deepak Udayakumar
- Internal Medicine Department, University of North Dakota, Fargo, ND, USA
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Abstract
A 73-year-old woman with chronic tophaceous gout presented with acute right-sided sciatica. Conventional radiology and CT scan of the lumbar spine revealed severe degenerative changes at the level of L3/4 and L4/5 disc and tophaceous deposits around the facet joints bilaterally. Investigations revealed a raised acute phase response (C reactive protein 97 mg/l, erythrocyte sedimentation rate >100 mm/h), leucocytosis and thrombocytosis. Because of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity and intolerance to colchicine, a local steroid infiltration of the L4-5 facet joint was administered with a partial response. The patient was treated with anakinra 100 mg daily administered for 3 days. The treatment led to rapid clinical improvement of sciatica as well as normalisation of the acute phase response. She was subsequently maintained on anakinra 100 mg three times weekly with total resolution of sciatic pain.
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Affiliation(s)
- Dominique Buenzli
- Centre Hospitalier Universitaire Vaudois, Medicine, Rue de Bugnon, Lausanne, 1011, Switzerland
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Bacteremia coexisting with tophaceous gout of the spine mimicking spondylodiscitis: a case report. Spine (Phila Pa 1976) 2009; 34:E106-9. [PMID: 19139655 DOI: 10.1097/brs.0b013e31818d051a] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report and review of the literature. OBJECTIVE To report a rare case of bacteremia coexisting with spinal gout initially suspected as pyogenic spondylodiscitis. SUMMARY OF BACKGROUND DATA Gouty spine is a rare disease. It is even rare when coexisting with bacteremia. The presentation as pain, fever, and positive blood culture will make it more difficult to distinguish from spinal infection. METHODS A 64-year-old woman with type II diabetes mellitus and chronic renal insufficiency was admitted to the emergency department with a fever of 39 degrees C, chills, and back pain. Laboratory studies revealed an elevated white count and neutrophils; her serum glucose level was 279 mg/dL. The C-reactive protein level was 25.55 mg/dL and serum uric acid was in the upper range of normal. Blood cultures revealed Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. Urine culture revealed 3 separate gram-negative bacilli. Magnetic resonance imaging of the spine revealed contrast enhancement in the L4-L5 and T5-T9 vertebral bodies. Infective spondylodiscitis of the lumbar and thoracic spine was suspected. RESULTS Because antibiotic treatment had failed, surgical debridement with diskectomy, partial corpectomy, and allogenous strut graft reconstruction (T8-T9) was performed. During the operation, 600 cc of pleural effusion was drained. Chalky white material was noted at the T8-T9 disc and the adjacent vertebral bodies. Cultures for bacteria, tuberculosis, and fungus were all negative. Histologic examination revealed deposition of eosinophilic crystal-like material, and a diagnosis of tophaceous gout of the spine was established. CONCLUSION This is, to our knowledge, the first case of bacteremia coexisting with multiple areas of tophaceous gout of the spine. Although uncommon, gouty spine should be added into the differential diagnosis of patients with back pain and bacteremia.
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Bibliography. Current world literature. Adrenal cortex. Curr Opin Endocrinol Diabetes Obes 2008; 15:284-299. [PMID: 18438178 DOI: 10.1097/med.0b013e3283040e80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yehia B, Flynn J, Sisson S. Crystal clear. Am J Med 2008; 121:488-90. [PMID: 18501227 DOI: 10.1016/j.amjmed.2007.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 11/06/2007] [Accepted: 12/11/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Baligh Yehia
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD 21205, USA.
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