Axial Gouty Arthropathy

Intradural Tophaceous Gout of the Cavernous Sinus and Spine: Case Report and Review of Literature

“…Fortunately, characteristic findings on magnetic resonance imaging (MRI) [13,14], computed tomography (CT) [15,16], or ultrasound [17] serve as useful adjuncts for proper diagnosis of spinal gout. Successful medical and surgical management of spinal gout has been previously described in the literature [1,4,[18][19][20].Whereas tophaceous gout of the calvarium [21], infratemporal fossa [22], middle ear [22,23], and cervicomedullary junction with involvement of lower cranial nerves [24] have been reported in the past, to our knowledge, intradural tophaceous gout has not been described. We present the first case of an individual with gouty tophi involving the cavernous sinus and the intradural spinal compartment.…”

“…Though spinal gout can involve any portion of the spine, the preponderance of lesions occur in the lumbar spine [1,2,4,7,8], and more than 80% of patients with gout may harbor multiple gouty lesions [2,4]. The clinical diagnosis of spinal gout remains a challenge because the common presenting findings such as fever, leukocytosis, and elevated systemic inflammatory markers such as sedimentation rate more commonly suggest infection [9][10][11][12].…”

“…Fortunately, characteristic findings on magnetic resonance imaging (MRI) [13,14], computed tomography (CT) [15,16], or ultrasound [17] serve as useful adjuncts for proper diagnosis of spinal gout. Successful medical and surgical management of spinal gout has been previously described in the literature [1,4,[18][19][20].…”

“…While gout is typically associated with an inflammatory arthritis of the peripheral joints, gouty involvement of the axial spine is a well-known and underreported source of back pain, radiculopathy, myelopathy, and even paraplegia [1][2][3][4]. Since Koskoff et al described the first case of extradural gout causing paraplegia [5], the radiographic prevalence of axial spine gout has been estimated to be between 14% and 35% in patients with poorly controlled hyperuricemia [2,[6][7][8].…”

“…While gout is typically associated with an inflammatory arthritis of the peripheral joints, gouty involvement of the axial spine is a well-known and underreported source of back pain, radiculopathy, myelopathy, and even paraplegia [1][2][3][4]. Since Koskoff et al described the first case of extradural gout causing paraplegia [5], the radiographic prevalence of axial spine gout has been estimated to be between 14% and 35% in patients with poorly controlled hyperuricemia [2,[6][7][8].Though spinal gout can involve any portion of the spine, the preponderance of lesions occur in the lumbar spine [1,2,4,7,8], and more than 80% of patients with gout may harbor multiple gouty lesions [2,4]. The clinical diagnosis of spinal gout remains a challenge because the common presenting findings such as fever, leukocytosis, and elevated systemic inflammatory markers such as sedimentation rate more commonly suggest infection [9][10][11][12].…”