Spinal Gout: A Great Mimicker A Case Report and Literature Review
Spinal Gout: A Great Mimicker A Case Report and Literature Review
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DOI：
10.1177/197140091202500518
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发表时间：
2012-10-01
影响因子：
1.2
通讯作者：
Tejada, J. G.
中科院分区：
文献类型：
--
作者：
Ahmad, I.;Tejada, J. G.
脊柱痛风并不像以前认为的那样罕见，它类似于异质性脊柱疾病，如类风湿性、脓毒性、血清阴性关节病和原发性或继发性肿瘤。影像学表现是非特异性的，通常表现较晚。在临床上，怀疑脊柱痛风，针吸活检可能有助于进一步表征。一名57岁男性，无明显既往病史，因持续一周的严重非放射性腰痛在急诊科就诊。他的实验室检查结果显示尿酸为642 μ mol/L，红细胞沉降率为93 mm/h，C反应蛋白为8.3 mg/dl。腰椎MRI显示非特异性急性炎性广泛腰椎小关节病和软组织强化。影像学和临床信息不足以区分脓毒性关节炎、类风湿性关节炎、血清阴性关节病或痛风。进行了腰椎小关节透视-透视CT引导下穿刺活检。活检显示双折射晶体阴性符合痛风。虽然脊柱痛风并不罕见，但很少有病例报告描述针吸活检和模拟物的作用。我们提出了一个比较审查有限的报告，针吸活检的作用，在模仿脊柱痛风。
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 mu mol/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.