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Rare disease
CASE REPORT
Spinal tophaceous gout presenting in a young adult without pain
  1. Zaid Al-Jebaje1,
  2. John Mellon Elibol2,
  3. Jonathan Peters3,
  4. Ali Alameri1
  1. 1Department of Internal Medicine, University at Buffalo Catholic Health, Buffalo, New York, USA
  2. 2Department of Internal Medicine, Mercy Hospital of Buffalo, Buffalo, New York, USA
  3. 3University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  1. Correspondence to Dr John Mellon Elibol, jelibol36{at}gmail.com

Summary

A 26-year-old man with a medical history of gout and morbid obesity presented with a 7-day history of decreased sensation to light touch and temperature from the feet to the level of the nipples. He also noted incomplete voiding. Laboratory investigations showed an elevated serum uric acid level (10.4 mg/dL, reference range: 3.8–8.7 mg/dL) as well as negative rapid plasma reagin and rheumatoid factor. MRI showed inflammatory changes on multiple spinal levels. Laminectomy was performed, with follow-up biopsy revealing multiple multinucleated giant cells and monosodium urate (MSU) crystals. He was ultimately diagnosed with spinal gout. Patient’s symptoms did not resolve immediately after surgery. Yet with the administration of intravenous glucocorticoids and a course of non-steroidal anti-inflammatory drugs, he slowly regained sensation, leaving the hospital with complete resolution of symptoms.

  • neurology
  • neurological injury
  • musculoskeletal and joint disorders

https://doi.org/10.1136/bcr-2018-224406

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    Footnotes

    • Contributors ZA-J, JME, JP and AA have all made substantial contributions to the conception of the work, as well as analysis and interpretation of data. They also collectively drafted and revised the work. Every author has approved the final version for publication and are in agreement to be accountable for the integrity of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.