Gout-Induced Cervical Deformity and Progressive Myelopathy Mimicking Infection Requiring Cervical Reconstruction

Abstract

IntroductionThis study describes a rare case where gout, a condition primarily associated with joint inflammation, initially manifested as a progressive cervical kyphotic deformity, mimicking infection and causing myelopathy. The patient, a previously healthy 56-year-old female, presented with severe jaw pain and a temporomandibular joint (TMJ) abscess, alongside two months of worsening balance and arm/hand tingling. Extensive clinical and radiographic assessments revealed a severe cervical kyphotic deformity with bony erosion at multiple vertebral levels, raising suspicion of an infectious cause of compressive myelopathy. MethodsThe patient underwent an urgent staged surgical intervention involving multilevel cervical decompression and fusion, coupled with cervical deformity correction. Post-surgery, she received antibiotics for seven days, during which pathological analysis unveiled collections of macrophages reacting to urate crystal deposition in a pattern consistent with gouty tophus. This unexpected diagnosis marked a novel case of undiagnosed gout-induced severe cervical deformity presenting with myelopathic symptoms and successfully managed through cervical spine deformity correction. ConclusionThis report underscores the significance of considering gout as a potential cause when encountering unusual spinal pathologies, especially in cases where gout-related symptoms are atypical. The presented 540-degree surgical approach effectively addressed both the cervical deformity and gout-induced myelopathic symptoms. To the best of our knowledge, this study represents the first documented instance of a patient with undiagnosed gout-induced severe cervical deformity successfully treated through cervical spine deformity correction, emphasizing the importance of vigilance and innovative management approaches in such rare clinical scenarios. As of the two-year follow-up, the patient exhibited significant symptom improvement and overall well-being.