A Man With Intractable Back Pain, Spondylodiscitis: A Case Report of Uncommon Site of Spinal Gout

Abstract

Gout typically affects the peripheral joints but uncommonly can involve the axial skeleton and rarely the intervertebral discs. We present a rare case of gouty spondylodiscitis affecting the intervertebral disc in the lumbar spine. Our patient with a gout history not on any maintenance therapy presented intractable rightsided back pain radiating to the right lower extremity. Computed tomography scan findings were consistent with spondylosis, while magnetic resonance imaging showed concern of infectious discitis. Initially, he was treated for infectious discitis with IV antibiotics. Biopsy of the L5-S1 disc space revealed monosodium urate crystals, confirming the diagnosis of gouty spondylodiscitis. He was managed with IV dexamethasone and recovered well on a tapering dose of steroids and colchicine followed by allopurinol once acute flare resolved.

Tophaceous spinal gout in a young man with complete spinal cord injury

“…Elevated ESR, CRP and WCC were reported in 25%, 16% and 13% of cases, respectively 10. Spinal gout is often misdiagnosed initially, common differentials include epidural abscess, cauda equina syndrome, chronic back pain, infective discitis and metastatic disease 11–13…”