Spinal gout tophus: a very rare cause of radiculopathy (original) (raw)
Related papers
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.
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 in the lumbar spine causing radiculopathy
Reumatología Clínica (English Edition), 2019
Tophaceous deposits in lumbar spine are considered a rare condition. We report the case of a 44-year-old patient with low back pain and radiculopathy. Radiographs revealed lytic spondylolisthesis in L5. Magnetic resonance imaging showed hypointense signal on T1 and a heterogeneous signal on T2 located in the L4-L5 interspinous space and in the left facet joint that invades left neuroforamen. The left knee ultrasound showed "double contour" of the medial femoral condyle. Decompressive laminectomy with arthrodesis at the level of L5-S1 was performed. The histological examination revealed amorphous material with a foreign body giant cell reaction.
Chronic tophaceous gout -A case report
Indian Journal of Orthopaedics Surgery, 2023
Background: Gout is an inflammatory arthritis associated with functional impairment and impact on quality of life. It arises when the tissues are supersaturated with urate leading to the formation of mono sodium urate crystals in and around the joints. This causes an inflammatory cascade resulting in secretion of several proinflammatory cytokines and neutrophil recruitment into the joint. Case Report: A 60 years old male patient presented with complaints of swelling in the posterior aspect of left elbow since 2 years and pain since 15 days. Examination revealed soft tissue swellings in multiple joints including metatarsophalangeal joint. Renal function tests show increased Uric acid (8.6mg/dl). On Gross examination, we received fibrofatty mass measuring 3.5x1.5x1 cm. Cut-section showed white flakes ? Calcifications. On microscopy, sections studied show fibrocollagenous tissue with several tophi made up of pink eosinophilic material surrounded by foreign body giant cell reaction and lymphocytes. There are several cystic spaces filled with calcareous debris. Conclusion: Hyperuricemia is the key risk factor for gout and is considered prerequisite for mono sodium urate crystal formation. Urate under excretion through kidney is the major mechanism for hyperuricemia. Tophus formation is the cardinal feature of advanced gout. Keywords: Gout, Hyperuricemia, Tophi.
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: 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.
Gouty Tophi in Spine Causing Complete Lower Limb Paralysis : A Rare Presentation of Gout
2019
Introduction: Gout is a common inflammatory arthritis affecting people worldwide, causing recurrent acute painful arthritis. A tophi, which is a painless swelling is one of the commonest consequences in long standing gouty arthritis patient. Typically, it is found on the hand, feet and pinna of the ears. Case Report: We report a rare presentation of gout in a previously healthy young man, who came with complete lower limb paralysis due to spinal cord compression by gouty tophi. He underwent surgical decompression procedure with good initial motor and sensory recovery, but deteriorate after developed other complications.
Topacheous gout as a rare cause of spinal stenosis in the lumbar region
Journal of Neurosurgery: Spine, 2005
✓ Despite the fact that gout is a common metabolic disorder, because its involvement of the axial skeleton is rare the diagnosis is often delayed, even in patients with long-standing gout who present with neurological deficits. The authors report the case of a woman with a history of extensive gout, emphasizing the clinical, radiological, and pathological features of a lumbar spinal stenosis.
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.