Tophaceous gout of the spine in a patient with no peripheral tophi: Case report and review of the literature (original) (raw)
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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
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.
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.
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.
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 ...
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.
Pseudorheumatoid disability man with chronic tophaceous gout: a case report
PubMed, 2013
Gout is a type of inflammatory arthropathy that affects the peripheral joints and results from the accumulation of monosodium urate (MSU) crystals in the synovial fluid and other tissues. This disease is the most common form of inflammatory arthritis in men over 40 years of age. The fundamental biochemical abnormality in gout is an increase in serum urate (SU) concentration. These needle-like crystals induce not only acute episodes of inflammatory process into the surrounding area, but also, in the long-term history of the disease, chronic inflammation that is associated with changes in articular and periarticular structures. The next step caused by deposited MSU crystals is represented by the tophus formation and chronic gouty synovitis. The presence of tophi has been associated with greater physical functional disability in gout patients. We presented a case of severe chronic tophaceous gout in a 48-year-old man with chronic hand arthritis and urolithiasis, to point the significance of complex assessment (clinical, functional, imagistic and histological exams) in the diagnosis of a soft tissue lesion, especially in hands.
Atypical musculoskeletal manifestations of gout in hyperuricemia patients
Open Access Rheumatology: Research and Reviews, 2019
Deposition of tophus is a common feature in chronic gout; however, signs and symptoms are not always well-pronounced in cases of uncommon sites. We report a case series of three patients, one with an acute locked knee suspected to be meniscus tear or intra-articular loose body, a second case with a lump on the dorsal hand suspected to be a benign lesion, and a third case with a finger flexion deformity with carpal tunnel syndrome; all three cases were later on found out to be tophaceous gout. White chalky monosodium urate crystal deposition was found to be the culprit of the symptoms of the patients.