Tophaceous gout of the spine: Case report and review of the literature

Marinho, Frederic; Zeitoun-Eiss, D.; Renoux, J.; Brasseur, J.-L.; Genestie, Catherine; Greniér, Philippe

doi:10.1016/j.neurad.2011.04.003

Cited by 9 publications

(8 citation statements)

References 9 publications

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“…By 2015, the number of reported cases of spinal gout has increased to 131, with more than 50 percent involving the lumbar spine [9]. The reported cases revealed that many spinal regions can be affected by gout [10]. This includes vertebral bodies, pedicules, laminae, interapophyseal cartilage, epidural spaces and intradural spaces [10].…”

Section: Discussionmentioning

confidence: 99%

“…The reported cases revealed that many spinal regions can be affected by gout [10]. This includes vertebral bodies, pedicules, laminae, interapophyseal cartilage, epidural spaces and intradural spaces [10]. In the comprehensive review of all spinal gout cases done by Toprover et al in 2015, 131 cases were reviewed including a comparison of diagnosis and treatment courses [9].…”

Section: Discussionmentioning

confidence: 99%

“…Symptoms of axial gout vary from fever, localized pain, spinal nerve root compression, spinal cord compression, cranial nerve palsy and even atlanto-axial subluxation [10]. Diagnosis of tophaceous spinal gout is extremely difficult in that patients usually present with nonspecific symptoms and the most accurate test to confirm its diagnosis is a needle biopsy with histology.…”

Section: Discussionmentioning

confidence: 99%

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Spinal gout causing reversible quadriparesis: a case report and literature review

Kaler

Mukhtar

Khalid

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Gout commonly affects peripheral joints and is rarely found in axial joints, such as the spine and sacroiliac joints. We report a case of a patient that presented with quadriparesis who was empirically treated for spinal gout and a review of relevant literature. A 77-year-old male presented with new-onset quadriparesis that developed over 3 days. MRI imaging was suggestive of tophaceous gout of the cervical spine, but our patient refused a spinal biopsy. He was empirically treated with high-dose steroids and his upper and lower extremities weakness started improving within 3 days and resolved completely. Although spinal gout is uncommon, this case indirectly suggests that gout should be kept as a differential diagnosis when faced with back pain or quadriparesis. This case implies that empiric treatment should be considered when radiographic evidence is suggestive of tophaceous gout of the spine.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Spinal gout causing reversible quadriparesis: a case report and literature review

Kaler

Mukhtar

Khalid

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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“…Uric acid was elevated in 70% of patients 1. MRI and CT investigations are considered non-specific, but may show homogenous changes on T1 and T2 imaging 11. Likewise, dual energy CT, which is used for identifying appendicular gout, is not ideal for imaging of spinal gout due to poor sensitivity for MSU crystals 12.…”

Section: Discussionmentioning

confidence: 99%

Spinal tophaceous gout presenting in a young adult without pain

Al-Jebaje¹,

Elibol²,

Peters

et al. 2018

BMJ Case Reports

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A 26-year-old man with a medical history of gout and morbid obesity presented with a 7-day history of decreased sensation to light touch and temperature from the feet to the level of the nipples. He also noted incomplete voiding. Laboratory investigations showed an elevated serum uric acid level (10.4 mg/dL, reference range: 3.8-8.7 mg/dL) as well as negative rapid plasma reagin and rheumatoid factor. MRI showed inflammatory changes on multiple spinal levels. Laminectomy was performed, with follow-up biopsy revealing multiple multinucleated giant cells and monosodium urate (MSU) crystals. He was ultimately diagnosed with spinal gout. Patient's symptoms did not resolve immediately after surgery. Yet with the administration of intravenous glucocorticoids and a course of non-steroidal anti-inflammatory drugs, he slowly regained sensation, leaving the hospital with complete resolution of symptoms.

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“…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].…”

mentioning

confidence: 99%

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

Ka¹,

Mm²,

Hm³

et al. 2015

J Neurol Disord

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IntroductionWith a worldwide incidence of 0.4% [1], gout is a prevalent metabolic disorder that results from the inappropriate metabolism of uric acid and deposition of monosodium urate crystals in tissues [2]. 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]. 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. Case PresentationA 61-year-old, African-American male with stage 1 chronic kidney disease, hypertension, and gout (uric acid levels <7.0 mg/dL maintained on allopurinol) presented to the outpatient neurosurgery clinic with headaches, diplopia, masticatory difficulty, and neuralgia along the third division of the left trigeminal nerve. On examination, he was found to have left abducens palsy, weakness of the left masseter, and trismus. MRI of the brain revealed a large lesion in the lateral wall of the left cavernous sinus and Meckel's cave as well as an incidental lipoma. The lesion appeared hypointense on T1-and T2-weighted images and demonstrated contrast enhancement. The soft tissue mass extended into the infratemporal and pterygopalatine fossae via the foramina ovale and rotundum, respectively ( Figure 1A-1C). Marked denervation atrophy of the masticator and pterygoid muscles was also noted. Follow-up MRI of the brain demonstrated further extension of the mass into the left superior orbital fissure. Surgical resection via a trans-Sylvian corridor was undertaken to prevent permanent ophthalmoplegia and blindness. Intra-operatively the cavernous sinus dura appeared thickened...

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Tophaceous gout of the spine: Case report and review of the literature

Cited by 9 publications

References 9 publications

Spinal gout causing reversible quadriparesis: a case report and literature review

Spinal gout causing reversible quadriparesis: a case report and literature review

Spinal tophaceous gout presenting in a young adult without pain

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

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