1237 - Case Report: Spinal Cord Injury due to Epidural Gout

Case Diagnosis: Spinal cord injury due to epidural gout

Case Description: Patient is a 29-year male without significant PMH except gout, who developed back pain and progressive lower extremity weakness and paresthesia, ultimately resulting in his inability to ambulate. He presented to an emergency department, where MRI revealed a mass in the T8-T9 dorsal epidural space, with cord compression and severe spinal stenosis. Physical exam confirmed his weakness and found sustained clonus and positive Babinski sign in the bilateral lower extremities, as well as decreased sensation distal to his umbilicus. He underwent T6-T10 posterior spinal fusion and T8-T9 laminectomy with removal of the epidural mass. Pathology of the mass showed gout with acute inflammation. He was treated with only colchicine; prednisone was avoided due to potential poor wound healing from recent procedure. He was later admitted to inpatient rehabilitation, where he showed improvement in his lower extremity strength, and he began ambulating short distances.

Discussions: Diagnosing spinal gout is difficult, because it is very rare and requires surgical excision and pathology examination to confirm. Its clinical presentation and radiologic findings can mimic other spinal tumors, cysts, hematomas, and abscesses. Serum uric acid level may also be artificially suppressed in the setting of acute gouty flare. In fact, in this case, his serum uric acid level was 6.7. Considering the relative good prognosis for recovery of function, gouty tumors should be considered and treated.

Conclusions: Although gout in the spinal canal is rare, it should be considered in the differential diagnoses for an epidural mass, especially in patients with a history of gout.