SHM Converge Scientific Abstract ePoster Gallery-Don't Count Out Gout: Spinal Gout Presenting as Vertebral Osteomyelitis

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This case describes a 51-year-old man with obesity, spinal stenosis, and known gout who presented with one week of worsening low back pain and bilateral radiculopathy. Although he had no bowel or bladder symptoms and was afebrile, labs showed marked inflammation and leukocytosis. MRI suggested L5-S1 discitis/osteomyelitis, so he was started on vancomycin and ceftriaxone. Because he did not improve, he underwent surgical decompression and debridement, but still failed to clinically improve.<br /><br />During hospitalization, he developed migratory, inflamed joints involving the shoulders, knees, ankles, and great toes, and had visible tophi on the elbow. This raised concern for septic arthritis versus a gout flare. Extensive infectious workup, including blood cultures, operative cultures, synovial fluid studies, chest x-ray, and echocardiogram, was negative. When corticosteroids were started, he improved dramatically and his inflammatory markers normalized. The illness was ultimately attributed to spinal gout.<br /><br />The discussion emphasizes that spinal gout is an uncommon and often overlooked form of gout that can mimic vertebral osteomyelitis, discitis, or epidural abscess. Fever, leukocytosis, and elevated ESR/CRP are common but nonspecific, and uric acid may be normal. MRI is often not diagnostic and may resemble infection, while CT is better for showing erosions and sclerotic changes. Treatment mirrors peripheral gout management with NSAIDs, colchicine, corticosteroids, and long-term urate-lowering therapy such as allopurinol. When infection cannot be excluded, biopsy or surgery may be necessary. Importantly, spinal gout specimens appear white and chalky rather than purulent, and a separate sample must be preserved in 100% alcohol because urate crystals dissolve in formalin.<br /><br />Clinical takeaway: spinal gout should remain on the differential in patients with back pain and inflammatory findings, especially those with a history of tophaceous gout.

Asset Subtitle

Bridget B. Hottenstein

Meta Tag

Author List Bridget B. Hottenstein, Vijairam Selvaraj

Category Clinical Vignettes

Concept Spinal Gout

Concept Gout

Concept Back Pain

Concept Spinal Infection

Concept Tophaceous Disease

Distinguished Non-Finalist

Presenter Organization Warren Alpert School of Medicine, Brown University Health

Presenting Author Bridget B. Hottenstein

Track Adult

Keywords

spinal gout

gout

low back pain

discitis

osteomyelitis

radiculopathy

tophi

corticosteroids

MRI

urate-lowering therapy

Spinal Gout

Gout

Back Pain

Spinal Infection

Tophaceous Disease