Tophaceous coot of the spine mimicking epidural infection: Case report andreview of the literature

OBJECTIVE AND IMPORTANCE: Tophaceous gout uncommonly affects the axial skel eton. The clinical presentations of gout of the spine range from back pain to quadriplegia. Gout that presents as back pain and fever may be difficult to distinguish from spinal infection. We present a case of a patient with tophaceous gout of the lumbar spine who was initially diagnosed with and tr eated for an epidural infection. The clinical and diagnostic features of to phaceous gout of the spine are reviewed. CLINICAL PRESENTATION: A 70-year-old man presented with a 2-day history of fever and back pain. A physical examination revealed that he had flank tend erness and evidence of polyarthritis affecting the elbows, knees, and right first metatarsophalangeal joint. A magnetic resonance imaging scan of the patient's lumbar spine showed an extensive area of abnormal gadolinium enha ncement of the paramedian posterior soft tissues from L3 to S1 with an area of focal enhancement extending into the right L4-L5 facet joint. INTERVENTION: A laminectomy was performed at L4-L5, and a chalky white mate rial in the facet joint was found eroding into the adjacent pars intra-arti cularis. Light and polarizing microscopy confirmed the presence of gouty to phus. No evidence of infection was found. CONCLUSION: Gouty arthritis of the spine is rare. Thirty-seven previous cas es have been reported. When the clinical presentation includes acute back p ain and fever, differentiation of spinal gout from spinal infection may be difficult. The clinical suspicion of spinal gout may lead to the correct di agnosis by a less invasive approach than exploration and laminectomy.