Tophaceous gout in the lumbar spine causing radiculopathy (original) (raw)
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Arthritis and Rheumatism, 1985
Monosodium urate crystal deposition in joints and periarticular connective tissue is a characteristic feature of chronic gout. Tophi are typically found in the joints of the appendicular skeleton; extraskeletal tophi are less commonly seen. Reports of tophi in the axial skeleton are rare, and there are only 6 reports of tophaceous deposits causing neurologic symptoms secondary to spinal cord or nerve root compression. We report the first case of radiculopathy caused by a tophus in a patient who did not have a history of polyarticular, tophaceous gout.
Evidence-based spine-care journal, 2014
Study Design Case report. Objective The objective of this study is to report the occurrence of tophaceous gout in the lumbar spine. Methods Using a case report to illustrate the key points of gout in the spine, we provide a brief review of gout in the literature as it relates to its orthopedic and spinal manifestations as well as guidelines for management. Results This case report details the occurrence of a large and clinically significant finding of tophaceous gout in the lumbar spine in a 24-year-old man with a known history of gout and a 3-year history of progressive back pain. Conclusion A high index of suspicion can assist in diagnosis of patients presenting with back pain or neurologic findings with a history of gout. A previous history of gout (especially the presence of tophi), hyperuricemia, and the radiological characteristics presented here should aid the clinician in making the diagnosis of spinal gout. Early diagnosis has the potential to prevent the need for surgical ...
Tophaceous gout of the spine: A case report and review of the literature
Tophaceous gout is the final phase in the development of gout. Tophi form from the deposition of monosodium urate crystals can be found in the surrounding joints and periarticular tissues. Accumulation of tophi in the spine is rare. We report a case of spinal gout involving the thoracic spine resulted in spinal cord compression and incomplete paraplegia. Surgery was performed for decompressing the spinal canal, and tophaceous gout is certified from intraoperative and histological examination. KeyWords: images study, spinal cord compression, tophaceous gout
Tophaceous gout of the lumbar spine mimicking an epidural abscess: MR featurew
American journal of …, 1996
We present the MR findings in a case of tophaceous gout of the lumbar spine with cauda equina compression, mimicking an epidural abscess. The diagnosis was clinically unsuspected and confirmed at laminectomy. Tophus material in the paraspinal soft tissues appeared intermediate in signal intensity and showed heterogeneous contrast enhancement.
Tophaceous Gout in the Cervical Spine
Internal Medicine, 2012
A 58-year-old woman with a three-year progressive history of chronic arthritis, had become disabled due to general malaise and fever. Her laboratory data revealed hyperuricemia and elevated levels of C-reactive protein. Neither rheumatoid factor nor anti-citrullinated peptide antibodies were present. We diagnosed her with tophaceous gout with uric crystalline revealed by the arthrocentesis of the elbow. 99m Tc scintigraphy also disclosed a significant uptake in the cervical spine. The CT of the patient's cervical spine revealed significant bone erosion and destruction. We diagnosed the cervical involvement of gout based on the exclusion of infections and sarcoidosis. Rheumatologists should be aware of this rare association.
Spinal gout tophus: a very rare cause of radiculopathy
European Spine Journal, 2011
Gout is a common metabolic disease characterized by the development of arthritis and nephropathy related to the deposition of monosodium urate crystals within the joints, periarticular tissues, skin and kidneys. Tophus formation seen around the spinal column is very rare, while occurrences of spinal gout tophus without systemic gout disease are much more unique. In our study, we report a spinal gout case that presented with right sciatica without previous history of systemic gout disease.
Journal of Clinical Neuroscience, 2005
We report a case of surgically proven tophaceous gout of the lumbar spine at the L5-S1 level that mimicked infectious spondylodiscitis and epidural abscess on magnetic resonance (MR) images in a 65-year-old woman. The spinal tophi were hypointense on T1weighted images; focally and strongly hyperintense on T2-weighted images; and heterogeneously, marginally enhancing on contrast-enhanced T1-weighted images. The aim of this report is to emphasize the importance of considering this disease entity in the differential diagnosis of an epidural mass in a patient with chronic back pain.
Tophaceous Gout of the Spine: MR Imaging Features
Clinical Radiology, 2002
To de®ne the magnetic resonance (MR) imaging features of tophaceous gout of the spine. MATERIALS AND METHODS: We present the MR imaging examinations of 4 patients with spinal tophaceous gout. Spin-echo T1-weighted and fast spin-echo T2-weighted images were obtained for all patients, and 2 patients had gadolinium-enhanced MR imaging studies. Corresponding computed tomography (CT) was performed in one patient. All images were evaluated for the characteristics of the gouty tophi. RESULTS: The gouty tophi were located at the lower thoracic (n 1) and lumbar (n 3) levels. All tophi yielded homogeneous intermediate to low signal on T1-weighted images and variable signal intensity on T2-weighted images, comprising small foci of very low signal intensity on all sequences. Gadolinium-enhanced MR imaging studies revealed homogeneous enhancement or heterogeneous peripheral enhancement. Diuse stippled calci®cations were found in the tophi on CT images. Periarticular tophi with juxtaarticular bony erosions around facet joints occurred in 3 patients. CONCLUSION: Spinal tophaceous gout should be considered in the dierential diagnosis when periarticular deposits contain very low signal foci on all MR imaging sequences. Hsu, C.-Y. et al. (2002) Clinical Radiology 57, 919±925.
Back Pain Due to Lumbar Gouty Flare -- A Prospective Diagnosis
The Journal of Rheumatology, 2013
We read with interest the article by Konatalapalli, et al 1. The authors described a computed tomographic (CT) study to assess the prevalence of spinal tophi or characteristic erosions (which also result from tophi 2) in patients with gout. The prevalence was rather high (around 35%), even higher than the rate previously reported by these authors in The Journal 3. As discussed, several factors may have influenced these results; the spine might be prone to monosodium urate (MSU) crystal deposition, because the spine is a common location for osteoarthritis 4 , and a predilection for osteoarthritic joints has been shown in gout 5. Clinical presentations of gout essentially relate to joint inflammation or either palpable tophi or problems related to them in different locations 6. Our knowledge about gouty spinal inflammation remains anecdotal. We recently had a case of axial involvement by gout. An 85-year-old man with a long history of crystal-proven tophaceous gout, irregularly followed and treated, came to our clinic walking with a