European Spine Journal

, Volume 27, Issue 4, pp 815–819 | Cite as

Tophaceous gout of the lumbar spine mimicking a spinal meningioma

  • Pedro Ribeiro da Cunha
  • António Judice Peliz
  • Marcos Barbosa
Grand Rounds

AbstractOpen image in new window

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.

Keywords

Tophaceous gout Lumbar spine Spinal meningioma Low back pain 

Notes

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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

The patient has consented to the submission of the case report to the journal.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Neurosurgery DepartmentCoimbra University Hospital CenterCoimbraPortugal

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