Topacheous gout as a rare cause of spinal stenosis in the lumbar region

Case report

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✓ 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.

Article Information

Address reprint requests to: Chris Lim, A.F.R.C.S.I., Research Registrar, Department of Neurosurgery, Cork University Hospital, Cork, Ireland. email: clim@eircom.net.

© AANS, except where prohibited by US copyright law.

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Figures

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    Plain radiograph demonstrating Grade 1 L4–5 spondylolisthesis.

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    Axial CT scan revealing an expansive destructive lytic lesion at the L-4 lamina and spinous process, with constriction of the cord.

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    Sagittal T2-weighted (left) and axial T1-weighted (right) MR images revealing the lamina bilaterally and the spinous process of L-4 infiltrated by tissue with expansion of the relevant osseous structures, extending into the spinal canal and compressing the thecal sac from behind.

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    Photomicrograph showing amorphous crystalline material surrounded by inflammation and multinucleated giant cells surrounding fibrillary gouty material. H & E, original magnification × 2000.

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    Sagittal T2-weighted (left) and axial T1-weighted lumbar MR images obtained 2 years after surgery, demonstrating postoperative changes at the previous operative site and no evidence of neural compression.

References

1.

Aaron SLMiller JDRPercy JS: Topheceous gout in the cervical spine. J Rheumatol 11:8628651984Aaron SL Miller JDR Percy JS: Topheceous gout in the cervical spine. J Rheumatol 11:862–865 1984

2.

Bonaldi VMDuong HStarr MRSarazin LRichardson J: Tophaceous gout of the lumbar spine mimicking an epidural abscess: MR features. AJNR 17:194919521996Bonaldi VM Duong H Starr MR Sarazin L Richardson J: Tophaceous gout of the lumbar spine mimicking an epidural abscess: MR features. AJNR 17:1949–1952 1996

3.

Duprez TPMalghem JVande Berg BCNoel HMMunting EAMaldague BE: Gout in the cervical spine: MR pattern mimicking diskovertebral infection. AJNR 17:1511531996Duprez TP Malghem J Vande Berg BC Noel HM Munting EA Maldague BE: Gout in the cervical spine: MR pattern mimicking diskovertebral infection. AJNR 17:151–153 1996

4.

Fenton PYoung SPrutis K: Gout of the spine. Two case reports and a review of the literature. J Bone Joint Surg Am 77:7677711995Fenton P Young S Prutis K: Gout of the spine. Two case reports and a review of the literature. J Bone Joint Surg Am 77:767–771 1995

5.

Gines RBates DJ: Tophaceous lumbar gout mimicking an epidural abscess. Am J Emerg Med 16:2161998Gines R Bates DJ: Tophaceous lumbar gout mimicking an epidural abscess. Am J Emerg Med 16:216 1998

6.

Hsu CYShih TTFHuang KMChen PQSheu JJLi YW: Tophaceous gout of the spine: MR imaging features. Clin Radiol 57:9199252002Hsu CY Shih TTF Huang KM Chen PQ Sheu JJ Li YW: Tophaceous gout of the spine: MR imaging features. Clin Radiol 57:919–925 2002

7.

King JCNicholas C: Gouty arthropathy of the lumbar spine: a case report and review of the literature. Spine 22:230923121997King JC Nicholas C: Gouty arthropathy of the lumbar spine: a case report and review of the literature. Spine 22:2309–2312 1997

8.

Kumar PJClarke ML: Clinical Medicineed 2. London: Balliere Tindall1990 pp 404405Kumar PJ Clarke ML: Clinical Medicine ed 2. London: Balliere Tindall 1990 pp 404–405

9.

Underwood JCE: General and Systemic Pathology. Edinburgh: Churchill Livingstone1992 pp 734736Underwood JCE: General and Systemic Pathology. Edinburgh: Churchill Livingstone 1992 pp 734–736

10.

Sabharwal SGibson T: Cervical gout. Br J Rheumatol 27:4134141988 (Letter)Sabharwal S Gibson T: Cervical gout. Br J Rheumatol 27:413–414 1988 (Letter)

11.

Souza AWSFontenele SCarrete H JrFernandes ARCFerrari AJL: Involvement of the thoracic spine in tophaceous gout. A case report. Clin Exp Rheumatol 20:2282302002Souza AWS Fontenele S Carrete H Jr Fernandes ARC Ferrari AJL: Involvement of the thoracic spine in tophaceous gout. A case report. Clin Exp Rheumatol 20:228–230 2002

12.

Staub-Schmidt TChaouat ARey DBloch JGChristmann D: Spinal involvement in gout. Arthritis Rheum 38:1391411995Staub-Schmidt T Chaouat A Rey D Bloch JG Christmann D: Spinal involvement in gout. Arthritis Rheum 38:139–141 1995

13.

Van de Laar MAFJvan Soesbergen RMMatricali B: Tophaceous gout of the cervical spine without peripheral tophi. Arthritis Rheum 30:2372381987Van de Laar MAFJ van Soesbergen RM Matricali B: Tophaceous gout of the cervical spine without peripheral tophi. Arthritis Rheum 30:237–238 1987

14.

Varga JGiampaolo CGoldenberg DL: Tophaceous gout of the spine in a patient with no peripheral tophi: a case report and review of the literature. Arthritis Rheum 28:131213151985Varga J Giampaolo C Goldenberg DL: Tophaceous gout of the spine in a patient with no peripheral tophi: a case report and review of the literature. Arthritis Rheum 28:1312–1315 1985

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