Department of Internal Medicine, Atrium Health Floyd Medical Center, Rome, GA, USA.
Department of Internal Medicine, Atrium Heath Floyd Medical Center, Rome, GA, USA.
Am J Case Rep. 2023 Mar 23;24:e938852. doi: 10.12659/AJCR.938852.
BACKGROUND Spinal gout is not so uncommon. The numbers of case reports are low because of underdiagnosis. Nevertheless, the presentation of spinal gout in a patient who was never diagnosed with gout or hyperuricemia is rare. In addition, the probability of occurrence of spinal gout at the thoracic spine is low, making this case unique. Late or missed diagnosis causes treatment delays with grave outcomes. CASE REPORT A 65-year-old man with a past medical history of chronic lymphocytic leukemia presented with rapid and progressive weakness of the lower extremities that led to complete paraplegia over 2 weeks. Magnetic resonance imaging showed severe central canal stenosis with disc protrusion and a T4-5 ventral mass with abnormal marrow signaling. The margins at the erosion were sclerotic, and malignancy was top on the differential diagnosis. Open minimally invasive laminectomy with discectomy at T4-5 was done. Sections on the biopsy specimen demonstrated fragments of benign cartilage and bone and multiple granulomas palisading around areas of crystalline material, consistent with tophaceous gout. He was started on a urate-lowering treatment per the American College of Rheumatology guideline. Unfortunately, due to the late patient presentation, neurologic recovery was not possible. CONCLUSIONS This case report illustrates an unusual presentation of gout with a catastrophic complication that could have been prevented with early diagnosis and treatment. Some reports have described patients with tophaceous deposits in the absence of gout flare among patients with urate overproduction due to myeloproliferative disorders. Further studies are needed to explore such relationships.
脊柱痛风并不罕见。由于诊断不足，病例报告数量较低。然而，从未被诊断为痛风或高尿酸血症的患者出现脊柱痛风的表现较为罕见。此外，脊柱痛风发生在胸椎的概率较低，这使得该病例较为独特。延迟或误诊会导致治疗延误，产生严重后果。
一名 65 岁男性，既往有慢性淋巴细胞白血病病史，出现下肢迅速进展性无力，2 周内导致完全截瘫。磁共振成像显示严重的中央椎管狭窄伴椎间盘突出和 T4-5 腹侧肿块，骨髓信号异常。侵蚀的边缘是硬化的，恶性肿瘤是鉴别诊断的首要考虑因素。行 T4-5 开放微创椎板切除术和椎间盘切除术。活检标本的切片显示良性软骨和骨的碎片以及围绕结晶物质区域的多个呈栅状排列的肉芽肿，符合痛风石性痛风。根据美国风湿病学会指南，他开始接受降尿酸治疗。不幸的是，由于患者就诊较晚，无法恢复神经功能。
本病例报告说明了痛风的一种不常见表现，并发灾难性并发症，如果早期诊断和治疗，本可以预防这种并发症。一些报告描述了一些患者在骨髓增生性疾病导致尿酸生成过多的情况下出现痛风石沉积，而没有痛风发作。需要进一步研究来探讨这种关系。
