Tophaceous gout in thoracic spine mimicking meningioma: A case report and literature review

Mishra, Ratish Kumar; Panigrahi, Vishnu Prasad; Adsul, Nitin; Jain, Sunila; Chahal, Rupinder; Kalra, K; Acharya, Shankar

doi:10.25259/sni_515_2020

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…Intraspinal gout tophi can be misdiagnosed as spondylitis, epidural abscess, neoplastic lesion, or degenerative stenosis [16][17][18][19]. The presence of clinical signs of spinal cord involvement in a patient with increased uric acid should suggest looking for intraspinal tophi; however, the definitive diagnosis for intraspinal tophi requires a histopathological examination [15,16].…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Compression Due to Tophaceous Vertebral Gout: A Case Report

Casas¹,

López-Piloto²,

Paz³

et al. 2022

Cureus

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Gout tophi are deposits of urate crystals in subcutaneous tissues and joints which commonly affect the small joints of the feet and hands, causing painful arthritis. The axial skeleton is considered to be seldom affected by gout arthritis. Here we describe the clinical, MRI, and pathologic findings of a 61-year-old male patient with a previous diagnosis of gout who presented with progressive paraparesis and radicular pain. MRI showed extradural masses compressing the spinal cord and roots at two spinal levels. Two surgical interventions were performed to remove these extradural masses, which were pathologically identified as gout tophi. Pain and paraparesis had clinical improvement after surgery. This report highlights that gout can be a cause of paraparesis.

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Section: Discussionmentioning

confidence: 99%

Spinal Cord Compression Due to Tophaceous Vertebral Gout: A Case Report

Casas¹,

López-Piloto²,

Paz³

et al. 2022

Cureus

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show abstract

“…Spinal tophaceous gout is not a common finding. In most cases in the literature, a diagnosis of spinal tophi was not initially suspected [ 7 , 17 , 18 , 24 , 25 ]. The most common clinical presentation was back and neck pain, followed by neurological impairment.…”

Section: Discussionmentioning

confidence: 99%

Gout Storm

et al. 2021

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Patient: Male, 55-year-old Final Diagnosis: Gout • spinal gout Symptoms: Back pain • fever • incontinence • pain • paresthesia of extremities • tachycardia Medication: — Clinical Procedure: Antibiotics • arthrocentesis • biopsy • CT scan • surgery • ultrasonography Specialty: General and Internal Medicine Objective: Unusual clinical course Background: Gout is a chronic disease characterized by deposition of monosodium urate crystals, typically manifesting as arthritis. Clinical presentation of gout usually results from activation of local inflammatory response. Despite being one of the oldest diseases in the world, gout pathophysiology is incompletely understood and clinical features are still surprising. Recent reports describe unusual manifestations including atypical joints involvement, tenosynovitis, panniculitis, and multinodular inguinal swelling. Another atypical feature is the acute polyarticular gout with severe systemic inflammatory response. Case Report: We report the case of a 55-year-old man presenting with fever, tachycardia, cauda equina syndrome, left-knee arthritis, and systemic inflammatory manifestations. Lumbar spine magnetic resonance imaging showed a 4.0×1.3×2.2 cm calcified mass inside the vertebral canal at the L4–L5 level, causing stenosis of the dural space and intervertebral foramen. Clinical diagnoses were septic knee arthritis and lumbar spine meningioma. Despite antibiotic therapy and left-knee surgical drainage, fever and increased C-reactive protein persisted, and arthritis developed in the elbows and right knee. As cultures were negatives, we then diagnosed gout flare in the affected joints accompanied by a severe systemic inflammatory reaction. A few days after starting colchicine and anti-inflammatory drugs, symptoms and inflammatory markers subsided. It was such a severe attack that we called it a “gout storm”. Conclusions: The report highlights the difficulty in diagnosing acute polyarticular gout affecting atypical joints, particularly when faced with a severe systemic inflammatory reaction.

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“…Although spinal gout has been reported previously at ages near that of our patient, the symptoms in those patients were less severe and progressed less rapidly. [7][8][9][10][11][12][13] Our case would suggest that an insidious progression of this clinical condition is not assured and that expeditious treatment may be most appropriate. The best management of cases in which spinal gout presents with neurological symptoms is rapid surgery for pathological diagnosis and decompression with subsequent pharmacological treatment to decrease uric acid levels.…”

Section: Lessonsmentioning

confidence: 99%

Gout in the thoracic spine causing acute paraplegia: illustrative case

Koro

Khanna

Richards

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Although spinal involvement by gout is not uncommon, spinal gout leading to symptomatic spinal cord compression in the thoracic spine is very rare and poses a diagnostic challenge by mimicking symptoms of more common diagnoses such as epidural abscess and malignancy. An even more unique presentation is spinal gout causing thoracic cord compression leading to acute paraplegia. OBSERVATIONS The authors present an illustrative case of a 35-year-old man with thoracic spinal compression by tophaceous gout who developed rapid progression to complete paraplegia over a 5-day period. Magnetic resonance imaging of the thoracic spine revealed a cystic-appearing lesion within the dorsal extradural space of the lower thoracic spine extending from T8 to T10 accompanied by compression of the spinal cord. An emergent T9–10 laminectomy was performed, and the occupying lesion in the thoracic spine was resected. The diagnosis of spinal tophaceous gout was made by pathological examination. LESSONS Although varying clinical manifestations of spinal gout have been reported in the literature, the patient’s age and the rapid progression to complete paraplegia over a 5-day period reveals a unique presentation that broadens understanding of the manner in which this condition can present and allow more rapid diagnosis and treatment.

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Tophaceous gout in thoracic spine mimicking meningioma: A case report and literature review

Cited by 6 publications

References 10 publications

Spinal Cord Compression Due to Tophaceous Vertebral Gout: A Case Report

Spinal Cord Compression Due to Tophaceous Vertebral Gout: A Case Report

Gout Storm

Gout in the thoracic spine causing acute paraplegia: illustrative case

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