Tophaceous spinal gout in a young man with complete spinal cord injury

Gout is a common inflammatory arthritis, caused by monosodium urate crystal deposition in the joints. Gout typically affects peripheral joints but less commonly it affects the spine. We report a case of a man in his 30s with chronic gout who presented acutely with thoracic back pain and flaccid paralysis of his lower limbs. CT showed abnormal facet joints at T8/9 with lucency suggestive of septic arthritis and MRI showed signal changes suggestive of epidural collection. The patient underwent emergency spinal surgery to evacuate the collection, followed by broad-spectrum antibiotic treatment. Cultures were negative; however, histopathology was suggestive of gout tophi. The patient was subsequently treated for spinal gout with prednisolone, allopurinol and colchicine and saw significant improvement in symptoms though he sustained a complete spinal cord injury. This case demonstrates that spinal gout is an important differential to consider in patients with chronic gout, presenting with acute back pain.