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Spinal gout mimicking paraspinal abscess: A case report.
Deepak Udayakumar1, Tarek Kteleh, Sarab Alfata
1Internal Medicine Department, University of North Dakota, Fargo, ND, USA.
Journal of Radiology Case Reports
|April 4, 2012
Summary
This case report highlights axial gout, a rare spinal manifestation of gout, presenting as paraspinal lesions. Diagnosis was confirmed by identifying monosodium urate crystals in fluid aspirated from the lesions.
Area of Science:
- Rheumatology
- Spinal Medicine
- Crystal-Induced Arthropathies
Background:
- Gout is typically considered a peripheral joint disease.
- Spinal involvement in gout is uncommon but documented.
- Paraspinal lesions can mimic infectious processes.
Purpose of the Study:
- To report a case of axial gout presenting as paraspinal muscle fluid collections.
- To illustrate the diagnostic challenges and eventual confirmation of spinal gout.
- To emphasize the importance of considering axial gout in cases of unexplained spinal lesions.
Main Methods:
- Magnetic Resonance Imaging (MRI) to identify paraspinal fluid collections.
- Empirical antibiotic treatment.
- Clinical observation of peripheral gout episode.
- Computed Tomography (CT) guided aspiration of lesions.
- Polarized microscopy for crystal identification.
Main Results:
- MRI revealed multiple small fluid collections in the paraspinal muscles (L3-L5).
- Initial antibiotic therapy was unsuccessful.
- A subsequent episode of peripheral gout occurred.
- CT-guided aspiration confirmed monosodium urate crystals in the paraspinal lesions.
Conclusions:
- Axial gout can present as paraspinal muscle lesions, mimicking infection.
- Diagnosis requires high clinical suspicion and confirmation of urate crystals.
- Early recognition and appropriate treatment are crucial for managing spinal gout.
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