Gout in the thoracic spine causing acute paraplegia: illustrative case

Lacin Koro,Ryan Khanna,Dominick Richards,Dean G Karahalios

doi:10.3171/case21308

Lacin Koro, Ryan Khanna + Show 2 more

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https://doi.org/10.3171/case21308

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Abstract

BACKGROUNDAlthough 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.OBSERVATIONSThe 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.LESSONSAlthough 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.

Highlights

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
Patients commonly present with back pain and neurological impairments often mimicking the symptoms of more common diagnoses such as epidural abscess, spondylodiscitis, and malignancy.[1]
We report a case of a 35-year-old male with thoracic spinal cord compression by tophaceous gout who developed progressive spastic paraplegia and lower extremity numbness acutely over a 5-day period

Summary

BACKGROUND

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. 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. Patients commonly present with back pain and neurological impairments often mimicking the symptoms of more common diagnoses such as epidural abscess, spondylodiscitis, and malignancy.[1] various clinical manifestations of spinal gout have been reported in the literature, this condition places a disproportionately greater burden on older adults with an extensive history of gout and rarely manifests with rapidly progressing paraplegia on initial presentation.[1] We report a case of a 35-year-old male with thoracic spinal cord compression by tophaceous gout who developed progressive spastic paraplegia and lower extremity numbness acutely over a 5-day period

Illustrative Case

Findings

Discussion