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A 75-year-old man with a history of gout presented with 5 days of fever and diffuse lower back pain. His temperature was 101.5 °F, and he had tenderness over both thoracic and lumbar vertebrae. His neurologic examination was largely normal. Erythrocyte sedimentation rate was 100 mm/h, and serum uric acid 18.6 mg/dL. Subsequent workup, including MRI and biopsy (figure), was consistent with tophaceous gout of the spine. Spinal gout is rarely reported, and can be mistaken for a spinal epidural abscess.1 A recent study suggests the frequency of axial involvement may be as high as 14% in patients with clinical or crystal-proven gout.2
Disclosure: Dr. Shenoi has received research support from the NIH (5 T32 AI007517) through Yale University, and is currently supported by the Fogarty International Clinical Fellowship (FICRF) (#R24TW007988). Her spouse, Ralph Brooks, was employed by and holds stock option in Merck & Company.
Address correspondence and reprint requests to Dr. Haakon B. Nygaard, Department of Neurology, Cellular Neuroscience, Neurodegeneration and Repair Program (CNNR), Yale University School of Medicine, 295 Congress Ave., BCMM 436, New Haven, CT 06536-0812; firstname.lastname@example.org