gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

The great deceiver: a 29-year-old patient with a large, erosive intraspinal and paravertral gout tophus

Ein Patient mit einem intraspinalem, paravertebralem destruierendem Gichttophus

Meeting Abstract

  • corresponding author C. Beier - Klinik und Poliklinik für Neurochirurgie, Universität Regensburg
  • A. Hartmann - Institut für Pathologie, Universität Regensburg
  • C. Woertgen - Klinik und Poliklinik für Neurochirurgie, Universität Regensburg
  • A. Brawanski - Klinik und Poliklinik für Neurochirurgie, Universität Regensburg
  • R. D. Rothoerl - Klinik und Poliklinik für Neurochirurgie, Universität Regensburg

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. DocP100

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0368.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Beier et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Symptomatic gout tophi of the spine are a rare complication of tophaceous gout. There are no typical symptoms and the tophus frequently mimics a spinal infection or tumor. We here report on a case history of a large lumbar gout tophus together with intraoperative, MRI and histological findings.

Methods

A 29-year-old previously healthy patient presenting with a L5 radiculopathy was refered to our department. The lumbar MRI revealed a 4.5x4.5x2.8 cm large process which enhanced contrast. It destroyed both L4/L5 facet joints and the left lamina L4 and further spread epidurally from L3 to L5 with compression of the left L5 root. There was no fever, but CRP and leucocyts were marginally elevated. Pain was resistant to conservative treatment and due to the destroying process with contrast enhancement, we saw an indication for surgery.

Results

An open biopsy was performed and the left sided L5 root was decompressed. The lesion consisted of chalky white material, all cultures taken remained sterile. The histological examination showed the typical picture of a gouty tophus with aggregates of urate crystals surrounded by an intense inflammatory reaction.

Conclusions

To our knowledge, our patient’s lesion is the largest ever published spinal gouty tophus. In line with previously reported cases of spinal gout tophus, its MRI appearance imitates an abscess or a malignant tumor. If gout is suspected and if there is no need for emergent decompression of neuronal structures, a CT-guided fine needle biopsy can establish the diagnosis. Then the pharmacological treatment should be optimized in order to prevent surgical procedures. In addition, the diagnosis of spinal gout will frequently be missed unless a histological examination is performed. The case report presented illustrates that despite all means of today’s radiology gout is still “the great deceiver” and has to be considered in cases of spinal infections without positives cultures.