Tophaceous Gout of the Lumbar Spine Mimicking Infectious Spondylodiscitis and Epidural Abscess
10.4184/jkss.2018.25.1.18
- Author:
Ju Seon JEONG
1
;
Heung Tae JEONG
;
In Seung LEE
;
Young Ha WOO
Author Information
1. Department of Orthopedic Surgery, Busan Bumin Hospital, Korea. woo0ha@naver.com
- Publication Type:Case Report
- Keywords:
Gout;
Epidural abscess;
Magnetic resonance imaging
- MeSH:
Administration, Intravenous;
Adult;
Back Pain;
Crystallins;
Diagnosis;
Diagnosis, Differential;
Discitis;
Epidural Abscess;
Epidural Space;
Fever;
Gadolinium;
Giant Cells;
Gout;
Humans;
Intervertebral Disc;
Magnetic Resonance Imaging;
Spine;
Spondylitis
- From:Journal of Korean Society of Spine Surgery
2018;25(1):18-23
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
STUDY DESIGN: Case report OBJECTIVES: We report a case of surgically proven tophaceous gout of the lumbar spine at the L5-S1 level in a 43-year-old man that mimicked infectious spondylodiscitis and epidural abscess on magnetic resonance (MR) images. SUMMARY OF LITERATURE REVIEW: Some patients have chronic back pain with an epidural mass. Among the many causes of epidural masses, tophaceous gout of the lumbar spine is very rare. MATERIALS AND METHODS: A 43-year-old man presented with fever and chronic back pain with radiating pain. In an MR image of L4-5, an abnormal subcutaneous mass was found in the posterior epidural space. The subcutaneous mass was isointense on T1-weighted images compared with the intervertebral disc, and focally and strongly hyperintense and heterogeneous on T2-weighted images. After the intravenous administration of gadolinium contrast, the mass was fairly homogenous, with a low signal intensity and without enhancement. With the diagnosis of infective spondylitis with epidural abscess, we performed a decompressive mass resection. RESULTS: The pathologic examination revealed multinuclear giant cells and amorphous crystalline fibrous tissue. The lesion was diagnosed as tophaceous gout. CONCLUSIONS: This case underscores the importance of considering tophaceous gout in the differential diagnosis of an epidural mass in a patient with chronic back pain.
