Dhaese Sofie, Stryckers Marijke, Van Der Meersch Hans, Terryn Wim, Van Laecke Steven
From the Renal Division, Department of Internal Medicine (SD, MS, HVDM, SVL), Ghent University Hospital, Ghent, and Department of Nephrology and General Internal Medicine, Jan Yperman Hospital (WT), Ypres, Belgium.
Medicine (Baltimore). 2015 Apr;94(13):e676. doi: 10.1097/MD.0000000000000676.
Axial gout is a well-documented but uncommon manifestation of gout. Its mimicking nature and the impracticality of axial joint aspiration might considerably delay its diagnosis. We report a case in a normouricemic renal transplant recipient, whereby the primary symptom of severe neck pain suggested pyogenic spondylodiscitis as an initial tentative diagnosis. Clinical findings included a high C-reactive protein concentration and elevated body temperature. The patient did not respond to empiric antibiotic treatment and suffered consecutive attacks of severe wrist and ankle pain in conjunction with a persistent fever. Blood and joint cultures were negative, but analysis of aspirated ankle joint fluid revealed monosodium urate crystals. A dual-energy computed tomography scan confirmed the presence of monosodium urate crystals in the costovertebral joints. Colchicine treatment dramatically improved the patient's clinical condition. Axial gout should be considered in transplant recipients with severe neck or back pain, fever, and increased inflammatory parameters with a high likelihood of an infectious etiology, despite the presence of paradoxically normal or even decreased serum urate concentrations. Dual-energy computed tomography is a noninvasive technique of possible benefit in the detection of axial gout when joint fluid aspiration is not deemed safe.
轴性痛风是一种有充分文献记载但并不常见的痛风表现形式。其具有的模仿特性以及对轴关节进行穿刺抽吸的不可行性，可能会显著延迟对它的诊断。我们报告一例尿酸正常的肾移植受者病例，该患者的主要症状为严重颈部疼痛，最初初步诊断为化脓性脊椎间盘炎。临床检查结果包括高C反应蛋白浓度和体温升高。患者对经验性抗生素治疗无反应，且连续出现严重的手腕和踝关节疼痛发作，并伴有持续发热。血液和关节培养均为阴性，但对抽吸的踝关节液进行分析发现了尿酸钠晶体。双能计算机断层扫描证实肋椎关节存在尿酸钠晶体。秋水仙碱治疗显著改善了患者的临床状况。对于出现严重颈部或背部疼痛、发热且炎症参数升高，极有可能存在感染病因的移植受者，即使血清尿酸浓度反常地正常甚至降低，也应考虑轴性痛风。当关节液抽吸被认为不安全时，双能计算机断层扫描是一种在检测轴性痛风方面可能有益的非侵入性技术。
