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Acute Microcrystalline Arthropathy Masquerades as Infectious Discitis

Jessita Albert Messiah Dhas, MD, Erik O’Connell, DO, & Lisa L. Schroeder, MD  |  Issue: June 2019  |  June 17, 2019

Bottom Line

Consider spinal gout in the differential diagnosis of patients with chronic kidney disease, a gout history and tophi presenting with acute back pain.


Jessita Albert Messiah Dhas, MDJessita Albert Messiah Dhas, MD, is a resident in the Department of Internal Medicine at Geisinger Medical Center, Danville, Pa.

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Erik O’Connell, DOErik O’Connell, DO, is rheumatology fellow in the Department of Rheumatology at Geisinger Medical Center, Danville, Pa.

Lisa Schroeder, MDLisa Schroeder, MD, is an attending physician in the Department of Rheuma­tology at Geisinger Medical Center, Danville, Pa.

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References

  1. Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: Therapy and anti-inflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken). 2012 Oct;64(10):1447–1461.
  2. Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012 Oct;64(10):1431–1446.
  3. Ahmad I, Tejada JG. Spinal gout: A great mimicker. A case report and literature review. Neuroradiol J. 2012 Nov;25(5):621–625.
  4. Toprover M, Krasnokutsky S, Pillinger MH. Gout in the spine: Imaging, diagnosis, and outcomes. Curr Rheumatol Rep. 2015 Dec;17(12):70.
  5. Cardoso FN, Omoumi P, Wieers G, et al. Spinal and sacroiliac gouty arthritis: Report of a case and review of the literature. Acta Radiol Short Rep. 2014 Sep 17;3(8):2047981614549269.
  6. Omoumi P, Verdun FR, Guggenberger R, et al. Dual-energy CT: Basic principles, technical approaches, and applications in musculoskeletal imaging (part 2). Semin Musculoskelet Radiol. 2015 Dec;19(5):438–445.
  7. Swan A, Amer H, Dieppe P. The value of synovial fluid assays in the diagnosis of joint disease: A literature survey. Ann Rheum Dis. 2002 Jun;61(6):493–498.
  8. Dalbeth N. Dual-energy computed tomography: Molecular imaging for gout. The Rheumatologist. 2014 Jun;8(6):40–41.
  9. Choi HK, Al-Arfaj AM, Eftekhari A, et al. Dual energy computed tomography in tophaceous gout. Ann Rheum Dis. 2009 Oct;68(10):1609–1612.
  10. Gruber M, Bodner G, Rath E, et al. Dual-energy computed tomography compared with ultrasound in the diagnosis of gout. Rheumatology (Oxford). 2014 Jan;53(1):173–179.

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Filed under:ConditionsGout and Crystalline Arthritis Tagged with:DiscitisGoutMicrocrystalline Arthropathy

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