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CASE REPORT
Rogue one: a story of tophaceous gout in the spine
  1. Karthik Dwarki1,2,
  2. Andy Dothard2,
  3. Bryan Abadie2,
  4. Matthew C Miles2
  1. 1 Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
  2. 2 Department of Anesthesia and Critical Care, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Karthik Dwarki, kdwarki{at}gwu.edu

Summary

A 26-year-old man with history of extensive tophaceous gout presented to the referring facility with decreased bilateral lower extremity sensation and motor function that began acutely 1 week prior to admission and had progressed to urinary incontinence. The patient was admitted to the intensive care unit due to concern for sepsis secondary to epidural abscess. The patient was started on empiric vancomycin and cefepime. Neurosurgery did not recommend acute neurosurgical intervention given the lack of a compressive lesion. Aspiration of the paraspinal collection by interventional radiology subsequently showed crystals consistent with tophaceous gout. Given the high initial suspicion for gout and results of the paraspinal aspiration, the patient was started on prolonged steroid taper as well as allopurinol and colchicine. The patient eventually had partial neurological recovery with discharge to an inpatient rehabilitation facility for further physical therapy rehabilitation.

  • medical education
  • medical management
  • neuroimaging
  • spinal cord
  • rheumatology
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Footnotes

  • Contributors All authors contributed to drafting and revising the manuscript.

  • 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 Parental/guardian consent obtained.

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

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