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.
References
Bonaldi VM, Duong H, Starr MR, Sarazin L, Richardson J (1996) Tophaceous gout of the lumbar spine mimicking an epidural abscess: MR features. AJNR Am J Neuroradiol 17:1949–1952
Hall MC, Selin G (1960) Spinal involvement in gout: a case report with autopsy. J Bone Joint Surg Am 42:341–343
Hou LC, Hsu AR, Veeravagu A, Boakye M (2007) Spinal gout in a renal transplant patient: a case report and literature review. Surg Neurol 67(1):65–73
Hu HJ, Liao MY, Xu LY (2015) Clinical utility of dual-energy CT for gout diagnosis. Clin Imaging 39(5):880–885
Kelly J, Lim C, Kamel M, Keohane C, O’Sullivan M (2005) Tophaceous gout as a rare cause of spinal stenosis in the lumbar region Case report. J Neurosurg Spine 2(2):215–217
King JC, Nicholas C (1997) Gouty arthropathy of the lumbar spine: a case report and review of literature. Spine 22:2309–2312
Levin MH, Lichetensein L, Scott HW (1956) Pathologic changes in gout; survey of eleven necropsied cases. Am J Pathol 32:871–895
Paquette S, Lach B, Guiot B (2000) Lumbar radiculopathy secondary to gouty tophi in the filum terminale in a patient without systemic gout: case report. Neurosurgery 46:986–988
Richette P, Bardin T (2010) Gout. Lancet 375:318–328
Sabharwal S, Gibson T (1988) Cervical gout. Br J Rheumatol 27:413–414 (letter)
Saketkoo LA, Robertson HJ, Dyer HR, Virk ZU, Ferreyro HR, Espinoza LR (2009) Axial gouty arthropathy. Am J Med Sci 338:140–146
Toprover M, Krasnokutsky S, Pillinger MH (2015) Gout in the spine: imaging, diagnosis and outcome. Curr Rheumatol Rep 17:70
Volkov A, Rhoiney DL, Claybrooks R (2014) Tophaceous gout of the lumbar spine: case report and review of the literature. Turk Neurosurg 25(6):954–958
Acknowledgements
We would like to thank Ricardo Pereira, M.D., for his thoughtful comments and assistance in the editing of the manuscript. The authors did not receive any funding or grants.
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Ribeiro da Cunha, P., Peliz, A.J. & Barbosa, M. Tophaceous gout of the lumbar spine mimicking a spinal meningioma. Eur Spine J 27, 815–819 (2018). https://doi.org/10.1007/s00586-016-4831-7
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DOI: https://doi.org/10.1007/s00586-016-4831-7