Chronic Tophaceous Gout in Multiple Spines: A Case Report and Literature Review

Kyoung Hwa Lee; Hyun Sun Woo; Mi Ryoung Seo; Hee Jung Ryu; Hyo Jin Choi; Han Joo Baek

doi:10.4078/jrd.2015.22.4.250

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Lee, Woo, Seo, Ryu, Choi, and Baek: Chronic Tophaceous Gout in Multiple Spines: A Case Report and Literature Review

Case Report

J Rheum Dis 2015;22(4):250-255.

Published online: 31 October 2015

DOI: https://doi.org/10.4078/jrd.2015.22.4.250

Chronic Tophaceous Gout in Multiple Spines: A Case Report and Literature Review

Kyoung Hwa Lee, Hyun Sun Woo, Mi Ryoung Seo, Hee Jung Ryu, Hyo Jin Choi, Han Joo Baek

Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea

Corresponding to: Han Joo Baek, Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea. E-mail: baekhj@gilhospital.com

Received 25 July 2014 Revised 10 September 2014 Accepted 10 September 2014

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Gout typically affects the 1st metatarsophalangeal joint. Spinal gout is rarely reported. Moreover, involvement of extensive spines is remarkably unusual. We describe a case of a 76-year-old woman with gout involving cervical, thoracic, and lumbar spines and sacroiliac joint. She presented with fever, severe back pain, and polyarthralgia and had multiple tophi on both el-bows and the left 2nd and 5th proximal interphalangeal (PIP) joints. Monosodium urate crystals were confirmed from tophi on the left 5th PIP joint by polarized optical microscopy. Magnetic resonance imaging and computed tomography showed joint space narrowing and bony erosions on cervical, thoracic, and lumbar spines, and sacroiliac joint. Fever, back pain, and polyarthralgia improved significantly with oral steroid therapy. Spinal gout can involve multiple spines and other joints and it can be improved by medical treatment only. It should be considered in patients with uncontrolled gout who have acute severe back pain.

Keywords: Axial, Gout, Multiple, Spine

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Figure 1.

Plain radiography. Joint space narrowing with small erosion at atlantoaxial joint is observed (A) and the subtle irregular shaped bony erosions in both sacroiliac joint are shown (right ＞ left) (B). Disc space narrowing with sclerotic marginated bony erosions are shown in the subchondral bone of from 6th to 11th thoracic vertebrae, from 2nd to 5th lumbar vertebrae and in the upper endplate of from 12th thoracic and the first lumbar vertebrae (C, D).

Figure 2.

Chest computed tomography. The axial view of T10 vertebrae (A) and the sagittal view of from T7 to T11 vertebrae (B) show the endplate bony erosions and disc space narrowing.

Figure 3.

Lumbar magnetic resonance imaging. Multiple well-defined bony erosions adjacent the disc space from 2nd to 5th lumbar vertebrae are revealed on T2-weighted image (A). T1-weighted image (B) and T2-weighted image (C) show well-defined bony erosions and extraosseous extension (arrows) and low signal intensity at 3rd and 4th lumbar vertebrae. In the contrastenhanced T1-wei-ghted image, these lesions are diffusely enhanced (D).

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