A 50‐year‐old man with a history of hypertension and gout presented with 2 weeks of bilateral lower‐extremity weakness and generalized fatigue. He was diagnosed 10 years ago with gout, initially controlled with antihyperuricemic drugs, but he recently became polyarticular and refractory to treatment. Medications included febuxostat, colchicine, amlodipine, and nonsteroidal anti‐inflammatories. Physical examination showed bilateral symmetric lower‐extremity paralysis and hyperreflexia, and a sensory level was noted over vertebrae T10. Laboratory examination was remarkable for a normal complete blood count and comprehensive metabolic panel and elevated erythrocyte sedimentation rate and C‐reactive protein, along with a high serum uric acid level (9.6 mg/dL). On further investigation, MRI imaging revealed a high T2 signal intensity in the spinal canal along with compression of the spinal cord at the T11–T12 level. CT‐guided aspiration demonstrated large amounts of intra‐ and extracellular negatively birefringent monosodium urate crystals along with prominent tophaceous formations. Coexistent infection was excluded. The patient underwent neurosurgical decompression. He regained lower‐extremity motor function.
Gout is commonly accepted as a peripheral joint disease of males. Axial disease is quite a rare manifestation of gout. Lumbar involvement predominates, with the most common finding being facet joint erosions. Cervical and thoracic spine as well as sacroiliac joints can also be involved. Literature on cord compression because of axial gout is limited to case reports and case series. MRI scan can assist in diagnosis, particularly with multifocal bone lesions. T1 sequence may have low to intermediate signal intensity and T2 intermediate to high signal in the gouty lesion. Monosodium urate deposition in biopsy specimen is diagnostic. Cultures of blood and of the biopsied lesion will rule out a coexistent infection. Laminectomy is the mainstay of treatment.
Axial gout should be considered in all cases of spinal cord impingement in patients with a history of gout or risk factors for this form of arthropathy. Early recognition is crucial to reverse the cord compression with timely surgical intervention and maintenance of urate‐lowering therapy.
R. Yachoui ‐ Cooper University Hospital, resident; J. P. ElKhoury ‐ Cooper University Hospital, resident; M. Sabbah ‐ Cooper University Hospital, resident.
To cite this abstract:Yachoui R, ElKhoury J, Sabbah M. Axial Gouty Arthropathy Causing Cord Compression. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 435. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/axial-gouty-arthropathy-causing-cord-compression/. Accessed March 29, 2020.