Ng Wesley, Sin Cheuk Hang, Wong Chong Hing, Chiu Wing Fat, Chung On Ming
Department of Orthopaedics and Traumatology, Princess Margaret Hospital, Hong Kong.
J Orthop Case Rep. 2017 Nov-Dec;7(6):50-54. doi: 10.13107/jocr.2250-0685.946.
Gouty spondyloarthropathy is generally believed to be uncommon. Together with the fact that it can mimic a variety of disease entities, it imposes significant diagnostic challenge in our clinical practice. In this article, we report two patients diagnosed with spinal gout, and both were initially suspected to have a pyogenic infection.
The first patient, a 66-year-old man, was admitted for fever and a short history of bilateral upper limb weakness. Clinical, biochemical, and radiological investigation results were suggestive of C5/6 infective spondylodiscitis with resultant cervical myelopathy. The second patient, a 68-year-old man, was admitted for fever and bilateral lower limb weakness and numbness compatible with cauda equina syndrome. Imaging showed L4/5 lytic spondylolisthesis with suspected abscesses formation around the pars defects. Both underwent emergency operations. Histological examinations of intraoperative specimens in both cases revealed tophaceous gout and microbiological studies were all negative. Urate-lowering agent was started for hyperuricemia. They both had partial neurological recovery.
These two cases highlight how axial gout can mimic infective spondyloarthropathy clinically. In patients with multiple risk factors for gout presenting with back conditions, spinal gout should be considered as one ofthe differential diagnosis. With the availability of advanced imaging modality, dual-energy computed tomography scan, pre-operative diagnosis of axial gout is now possible which may have implications on subsequent surgical approaches and medical treatment. Collaboration with the medical team to achieve good serum urate control is important to prevent disease recurrence.
痛风性脊椎关节病通常被认为并不常见。鉴于其可模仿多种疾病实体，在我们的临床实践中构成了重大的诊断挑战。在本文中，我们报告了两名被诊断为脊柱痛风的患者，两人最初均被怀疑患有化脓性感染。
首例患者为一名66岁男性，因发热及双侧上肢无力的短暂病史入院。临床、生化及影像学检查结果提示为C5/6感染性脊椎椎间盘炎并导致颈髓病。第二例患者为一名68岁男性，因发热及与马尾综合征相符的双侧下肢无力和麻木入院。影像学检查显示L4/5溶骨性脊椎滑脱，椎弓根缺损周围疑似有脓肿形成。两人均接受了急诊手术。两例患者术中标本的组织学检查均显示为痛风石性痛风，微生物学研究均为阴性。针对高尿酸血症开始使用降尿酸药物。两人的神经功能均有部分恢复。
这两例病例凸显了轴向痛风在临床上如何能够模仿感染性脊椎关节病。对于有痛风多种危险因素且出现背部疾病的患者，脊柱痛风应被视为鉴别诊断之一。随着先进成像模式双能计算机断层扫描的应用，现在可以对轴向痛风进行术前诊断，这可能对后续的手术方法和药物治疗产生影响。与医疗团队合作以实现良好的血清尿酸控制对于预防疾病复发很重要。
