Spinal Gout: A Great Mimicker

Abstract

Spinal gout is not as rare as was previously thought and mimics heterogeneous spinal conditions such as rheumatoid, septic, seronegative arthropathies and primary or secondary neoplasms. Imaging findings are nonspecific and usually manifest late. In clinical settings, suspicious for spinal gout, needle biopsy may help for further characterization. A 57-year-old man with no significant past medical history presented in the emergency department with severe non radiating low back pain of one week duration. His laboratory tests were significant for uric acid of 642 μmol/L, erythrocyte sedimentation rate 93 mm/hour, and C-reactive protein 8.3 mg/dl. The lumbar spine MRI showed nonspecific acute inflammatory extensive lumbar facet arthropathy and soft tissue enhancement. The radiological and clinical information was insufficient to differentiate among septic arthritis, rheumatoid arthritis, seronegative arthropathy or gout. A lumbar facet fluoroscopy-fluoroscopic CT-guided needle biopsy was performed. The biopsy demonstrated negative birefringent crystals consistent with gout. Although the spinal gout is not rare, few case reports describe the role of needle biopsy and mimics. We present a comparative review of limited reports addressing the role of needle biopsy in mimics of spinal gout.