Abstract
BackgroundGout is a monosodium urate deposition disease which is prevalent worldwide. The usual manifestations are crystal arthropathy and tophi deposition in the soft tissues. Spinal tophi may also occur and are rarely reported, resulting in various clinical manifestations such as back pain, spinal cord compression, radiculopathy, and even mimicking epidural abscess and spondylodiscitis.Case presentationWe report a case of a 42-year-old Chinese man with underlying gout who presented with back pain and radiculopathy. The diagnosis of spinal tophi was unsuspected and he was initially treated for epidural abscess and spondylodiscitis. He underwent a laminectomy and posterolateral fusion during which tophus material was discovered. He recovered and medications for gout were started.ConclusionSpinal tophi are rare. The diagnosis is difficult and spinal tophi may be mistaken for epidural abscess, spondylodiscitis, or neoplasm.
Highlights
Gout is a monosodium urate deposition disease which is prevalent worldwide
Deposition of monosodium urate crystals in the joints result in gouty arthritis and deposition of monosodium urate crystals in the soft tissue result in tophi formation
We present a case of a patient with back pain with radiculopathy due to spinal tophi
Summary
Gout is a monosodium urate deposition disease [1]. Deposition of monosodium urate crystals in the joints result in gouty arthritis and deposition of monosodium urate crystals in the soft tissue result in tophi formation. His past medical history included gout which was diagnosed 4 years ago He had monthly recurrent gouty arthritis, which affected his first metatarsophalangeal joints, ankles, knees, and shoulders. A percutaneous biopsy was not performed as the clinical suspicion for epidural abscess and spondylodiscitis was high and the differential diagnoses of tumor and spinal tophi were not suspected. He underwent surgery to drain the abscess and laminectomy and posterolateral fusion. Acid-fast bacilli smears were negative, and tuberculosis culture was negative During the admission, he had a flare of gouty arthritis of his right wrist and metacarpophalangeal joints. His back pain improved and he was started on allopurinol for urate-lowering therapy
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