Thoracic spinal gout mimicking metastasis.

Area of Science:

• Rheumatology
• Orthopedic Surgery
• Radiology

Background:

• Gout is a prevalent metabolic disorder characterized by hyperuricemia and urate crystal deposition.
• Spinal gout is an exceptionally rare manifestation, often presenting with non-specific symptoms and challenging diagnostic imaging.
• Tophaceous gout involves chronic urate crystal accumulation, potentially affecting various anatomical sites.

Observation:

• A 76-year-old male with a history of tophaceous gout presented with progressive bilateral lower limb weakness.
• Thoracic spine magnetic resonance imaging (MRI) revealed erosions in the T8 and T10 pedicles.
• Initial imaging interpretation suggested metastatic disease, necessitating further investigation.

Findings:

• Computed tomography (CT)-guided biopsy of the T10 thoracic lesion confirmed the presence of gouty arthritis.
• Histopathological analysis identified monosodium urate crystals, establishing the diagnosis of spinal gout.
• The imaging findings mimicked metastatic bone lesions and spondylodiscitis.

Implications:

• CT-guided fine-needle aspiration or biopsy is recommended for diagnosing spinal gout due to non-specific imaging features.
• Early and accurate diagnosis of spinal gout is essential to prevent misdiagnosis and ensure appropriate management.
• This case highlights the importance of considering rare diagnoses in patients with a history of tophaceous gout presenting with spinal symptoms.