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WHEN TOPHACEOUS GOUT INVOLVES MULTIPLE ORGANS: CHALLENGES AND SOLUTIONS.

G El Hasbani1, A Megahed2, M Cassetta1

  • 1"St Vincent's" Medical Center.

Acta Endocrinologica (Bucharest, Romania : 2005)
|August 21, 2023
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Summary
This summary is machine-generated.

Chronic gout can cause tophi deposits, leading to rare complications like hypercalcemia. This case shows spinal cord tophi causing PTH-independent hypercalcemia, resolving only with pegloticase therapy.

Keywords:
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Area of Science:

  • Rheumatology
  • Endocrinology
  • Nephrology

Background:

  • Uncontrolled chronic gout leads to monosodium urate crystal deposition (tophi).
  • Tophi can affect various organ systems, including unusual sites like the vertebrae.
  • Hypercalcemia is a rare but serious complication associated with gouty tophi.

Purpose of the Study:

  • To present a case of spinal cord tophi causing severe hypercalcemia.
  • To highlight the challenges in managing hypercalcemia secondary to tophi.
  • To demonstrate the efficacy of pegloticase in resolving refractory hypercalcemia in this context.

Main Methods:

  • Case report of a 62-year-old male with a history of gouty tophi.
  • Investigation of back pain revealing spinal cord involvement.
  • Monitoring of serum calcium and parathyroid hormone (PTH) levels.
  • Treatment with pegloticase for refractory hypercalcemia.

Main Results:

  • The patient presented with back pain and spinal cord tophi.
  • PTH-independent hypercalcemia was diagnosed.
  • Aggressive interventions failed to resolve hypercalcemia.
  • Hypercalcemia resolved completely following pegloticase therapy.

Conclusions:

  • Spinal tophi can cause significant complications, including refractory hypercalcemia.
  • Pegloticase therapy can be effective in managing hypercalcemia associated with gouty tophi.
  • This case underscores the importance of considering unusual presentations of gouty tophi.