Mishra Ratish, Panigrahi Vishnu Prasad, Adsul Nitin, Jain Sunila, Chahal R S, Kalra K L, Acharya Shankar
Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India.
Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India.
Surg Neurol Int. 2020 Oct 29;11:364. doi: 10.25259/SNI_515_2020. eCollection 2020.
Gout is a common metabolic disorder of purine metabolism, causing arthritis in the distal joints of the appendicular skeleton. Spine involvement is rare, and very few cases of spinal gout have been reported. The authors present a rare case of axial gout with tophaceous deposits in the thoracic spinal canal resulting in cord compression and mimicking a meningioma.
A 33-year-old male presented with chronic mid back pain and a progressive paraparesis. The presumed diagnosis was meningioma based on MR imaging with/without contrast that showed a posterolateral, right-sided, and T10-T11 intradural extramedullary lesion. Notable, was hyperuricemia found on hematological studies. The patient underwent a decompressive laminectomy (T9-T11) for excision of the lesion, intraoperatively, an intraspinal, chalky, white mass firmly adherent to and compressing the dural sac was removed. The histopathology confirmed the diagnosis of a gouty tophus. Postoperatively, the patient's pain resolved, and he regained the ability to walk.
A gouty tophus should be included among the differential diagnostic considerations when patients with known hyperuricemia present with back pain, and paraparesis attributed to an MR documented compressive spinal lesion.
痛风是一种常见的嘌呤代谢性疾病，可导致四肢骨骼远端关节的关节炎。脊柱受累罕见，仅有极少数脊柱痛风病例报道。作者报告了一例罕见的轴性痛风病例，其在胸段椎管内有痛风石沉积，导致脊髓受压，临床表现类似脑膜瘤。
一名33岁男性，表现为慢性中背部疼痛和进行性双下肢轻瘫。根据增强或未增强磁共振成像显示胸10-胸11节段右侧硬膜内髓外病变，初步诊断为脑膜瘤。值得注意的是，血液学检查发现高尿酸血症。患者接受了减压性椎板切除术（胸9-胸11）以切除病变，术中切除了一个附着并压迫硬膜囊的脊髓内灰白色肿块。组织病理学确诊为痛风石。术后患者疼痛缓解，恢复了行走能力。
当已知高尿酸血症患者出现背痛和双下肢轻瘫，且磁共振成像显示有脊髓压迫性病变时，痛风石应列入鉴别诊断考虑范围。
