Article Text

Severe systemic inflammatory response syndrome immediately after spinal surgery in a patient with axial gout
  1. Ricardo Gago1,
  2. Salvador Vilá1,
  3. Jonathan Vélez-Rivera2,
  4. Luis M Vilá1
  1. 1Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
  2. 2Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
  1. Correspondence to Dr Luis M Vilá, luis.vila2{at}


We report a 55-year-old man with gouty arthritis who developed a 3-month history of low back pain, gradual lower extremities weakness and urinary incontinence. Lumbar MRI showed an exophytic lesion at L3–L4. Immediately after spinal decompression surgery, he developed fever, disorientation, polyarthritis, acute kidney injury and leucocytosis. He was treated with multiple antimicrobial agents for presumed spinal abscess but did not improve. Multiple body site cultures were negative. Aspiration of the sacroiliac joint revealed the presence of monosodium uric acid crystals. A diagnosis of acute gout was done, and he was treated with high-dose intravenous methylprednisolone and colchicine. Within 48 hours, he had a remarkable clinical improvement. At discharge, neurological and laboratory abnormalities had resolved. Awareness of risk factors for axial gout and a high degree of suspicion are important to establish a prompt diagnosis and treatment to prevent severe complications as seen in this case.

  • rheumatology
  • medical management

Statistics from


  • Contributors Substantial contribution to acquisition of data, drafting the article or revising it critically for important intellectual content and final approval of the version of the article to be published: RG, SV, JV-R and LMV.

  • Competing interests None declared.

  • Patient consent Obtained.

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

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.