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Spinal involvement in gout

T Staub-Schmidt1, A Chaouat, D Rey

  • 1Unité des Maladies Infectieuses et Tropicales, Hôpital Civil, Hôpitaux Universitaires de Strasbourg, France.

Arthritis and Rheumatism
|January 1, 1995
PubMed
Summary
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Severe gout can manifest as bone lesions, mimicking other conditions. This case highlights tophaceous gout presenting as an asymptomatic lytic bone lesion in a patient with septicemia and dysglobulinemia.

Area of Science:

  • Rheumatology
  • Orthopedic Oncology
  • Infectious Diseases

Background:

  • Gout is a common inflammatory arthritis characterized by hyperuricemia and urate crystal deposition.
  • Biclonal dysglobulinemia is a rare condition involving two distinct immunoglobulin abnormalities, sometimes associated with plasma cell disorders.
  • Staphylococcus aureus septicemia is a serious bloodstream infection requiring prompt treatment.

Observation:

  • A 45-year-old male patient presented with Staphylococcus aureus septicemia.
  • The patient had a history of severe gout and biclonal dysglobulinemia without evidence of multiple myeloma.
  • Radiographic imaging revealed an asymptomatic lytic lesion in the L5 vertebral pedicle.

Findings:

  • Histopathological examination of the biopsied L5 lesion confirmed it to be typical tophaceous gout.

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  • The findings indicate that tophaceous gout can present as a destructive bone lesion, mimicking metastatic disease or myeloma.

    • Implications:

    • This case underscores the importance of considering tophaceous gout in the differential diagnosis of lytic bone lesions, particularly in patients with a history of gout.
    • Accurate diagnosis is crucial to avoid unnecessary aggressive treatments for conditions like myeloma or bone metastases.
    • Further research may elucidate the mechanisms underlying urate crystal-induced bone destruction in severe gout.