Journal List > J Korean Soc Spine Surg > v.25(1) > 1076166

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

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.

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).
jkss-25-18f1.tif
Fig. 2.
After laminectomy, gout tophi were found (A). The epidural area was decompressed and the gout tophi were removed (B).
jkss-25-18f2.tif
Fig. 3.
Postoperative sagittal magnetic resonance imaging (A). After decompressive surgery, the thecal sac had expanded (B).
jkss-25-18f3.tif
Fig. 4.
Multiple granulomas composed of inflammatory cells (macrophages, lymphocytes, plasma cells, and giant cells) surrounding the area of crystals (A, ×40; B, ×200).
jkss-25-18f4.tif
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