Tophaceous Gout of the Lumbar Spine Mimicking Infectious Spondylodiscitis and Epidural Abscess

Ju-Seon Jeong; Heung-Tae Jeong; In-Seung Lee; Young-Ha Woo

doi:10.4184/jkss.2018.25.1.18

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Jeong, Jeong, Lee, and Woo: Tophaceous Gout of the Lumbar Spine Mimicking Infectious Spondylodiscitis and Epidural Abscess

Case Report

Journal of Korean Spine Surg 2018;25(1):18-23.

Published online: 31 March 2018

DOI: https://doi.org/10.4184/jkss.2018.25.1.18

Tophaceous Gout of the Lumbar Spine Mimicking Infectious Spondylodiscitis and Epidural Abscess

Ju-Seon Jeong, M.D., Heung-Tae Jeong, M.D., Ph.D., In-Seung Lee, M.D., Young-Ha Woo, M.D.

Department of Orthopedic Surgery, Busan Bumin Hospital

Corresponding author: Young Ha Woo, M.D. ORCID ID: Young-Ha Woo: https://orcid.org/0000-0002-3102-7260 Ju-Seon Jeong: https://orcid.org/0000-0003-1914-3311 Heung-Tae Jeong: https://orcid.org/0000-0001-6594-6399 In-Seung Lee: https://orcid.org/0000-0002-1547-6859 Department of Orthopedic Surgery, Busan Bumin Hospital, 59 Mandeok-daero, Buk-gu, Busan 46555, Korea TEL: +82-51-330-3082, FAX: +82-51-330-3075 E-mail: woo0ha@naver.com

Received 16 July 20175 September 2017 Accepted 19 December 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Case report

Objectives

We report a case of surgically proven tophaceous gout of the lumbar spine at the L5-S1 level in a 43-year-old man that mimicked infectious spondylodiscitis and epidural abscess on magnetic resonance (MR) images.

Summary of Literature Review

Some patients have chronic back pain with an epidural mass. Among the many causes of epidural masses, tophaceous gout of the lumbar spine is very rare.

Materials and Methods

A 43-year-old man presented with fever and chronic back pain with radiating pain. In an MR image of L4-5, an abnormal subcutaneous mass was found in the posterior epidural space. The subcutaneous mass was isointense on T1-weighted images compared with the intervertebral disc, and focally and strongly hyperintense and heterogeneous on T2-weighted images. After the intravenous administration of gadolinium contrast, the mass was fairly homogenous, with a low signal intensity and without enhancement. With the diagnosis of infective spondylitis with epidural abscess, we performed a decompressive mass resection.

Results

The pathologic examination revealed multinuclear giant cells and amorphous crystalline fibrous tissue. The lesion was diagnosed as tophaceous gout.

Conclusions

This case underscores the importance of considering tophaceous gout in the differential diagnosis of an epidural mass in a patient with chronic back pain.

Keywords: Gout, Epidural abscess, Magnetic resonance imaging

REFERENCES

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Fig. 1.

Enhanced sagittal magnetic resonance imaging (MRI) (A). Enhanced axial MRI shows a lesion mimicking an epidural abscess (B).

Fig. 2.

After laminectomy, gout tophi were found (A). The epidural area was decompressed and the gout tophi were removed (B).

Fig. 3.

Postoperative sagittal magnetic resonance imaging (A). After decompressive surgery, the thecal sac had expanded (B).

Fig. 4.

Multiple granulomas composed of inflammatory cells (macrophages, lymphocytes, plasma cells, and giant cells) surrounding the area of crystals (A, ×40; B, ×200).

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