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JCR: Journal of Clinical Rheumatology:
doi: 10.1097/RHU.0b013e3181c51ea9
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Tophaceous Gout of the Lumbar Spine

Ko, Kai-Hsiung MD; Huang, Guo-Shu MD; Chang, Wei-Chou MD

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From the Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

Correspondence: Guo-Shu Huang, MD, Department of Radiology, Tri-Service General Hospital, 325, Cheng-Kung Road, Sec. 2, Taipei, 114, Taiwan, Republic of China. E-mail: gsh5@seed.net.tw.

A 63-year-old man visited our emergency room with a complaint of progressing low back pain for 2 months. He denied any history of trauma or spinal injuries. Neurologic examination revealed hyperesthesia of left S1 dermatomes. Laboratory findings were normal except for an elevated level of uric acid (9.7 mg/dL). Radiographs of lumbar spine showed only spondylosis (Fig. 1). Magnetic resonance imaging disclosed a soft tissue mass over the left L5–S1 facet joint, which demonstrated intermediate to low signal intensity on T1-weighted image, low signal intensity on T2-weighted image, and heterogeneous enhancement on gadolinium-enhanced T1-weighted image (Fig. 2). Computed tomography revealed bone erosion and the soft tissue mass with punctate calcifications in the left L5–S1 facet joint causing compression of left S1 root (Fig. 3). The patient underwent partial laminectomy and facetectomy with removal of the mass. Gouty tophi were confirmed by the pathohistologic examination showing granulomatous tissue with thin needle-shaped crystals that were negatively birefringent in polarized light. The patient was free of symptoms on 1-year follow-up.

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Gouty tophi involving the spine are rare and may produce a variety of symptoms, ranging from localized pain to cord compression or paraplegia.1,2 Gouty arthropathy may be underestimated by radiographs. MR patterns of signal and morphology of tophaceous gout may simulate those of the pigmented villonodular synovitis and amyloidosis. Computed tomography is more sensitive than magnetic resonance imaging to detect intraarticular or periarticular calcifications and bone erosions.3

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REFERENCES

1. Hsu CY, Shih TT, Huang KM, et al. Tophaceous gout of the spine: MR imaging features. Clin Radiol. 2002;57:919–925.

2. Hausch R, Wilkerson M, Singh E, et al. Tophaceous gout of the thoracic spine presenting as back pain and fever. J Clin Rheumatol. 199;6:335–341.

3. Gerster JC, Landry M, Duvoisin B, et al. Computed tomography of the knee joint as an indicator of intraarticular tophi in gout. Arthritis Rheum. 1996;39:1406–1409.

© 2010 Lippincott Williams & Wilkins, Inc.

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