Thoracic spinal gout mimicking metastasis.

A 76-year-old man was admitted in March 2007 to the orthopaedic department for investigation of lower limb weakness and malaise. He had a long history of gout treated with allopurinol and gave no history of trauma. On physical examination, the patient appeared cachectic and had multiple subcutaneous nodules suggesting gouty tophi in both hands and both elbows. His lower limb power was normal but both knee jerks were brisk. Blood tests revealed anaemia (haemoglobin, 111 g/L) and an erythrocyte sedimentation rate above 100 mm/h. His white cell count was normal but his alkaline phosphatase was elevated to 300 IU/L. A radiograph of his thoracolumbar spine revealed mild degenerative changes but no definite bony erosions were noted. Computed tomography (CT) of his thoracic spine showed well-defined, non-calcified, lytic lesions in the left pedicles of the T8 and T10 vertebrae (Fig 1a). Contrast-enhanced magnetic resonance imaging (MRI) of the thoracic spine showed that the lytic lesions in the left pedicles of T8 and T10 were isointense on T1-weighted imaging and slightly hypointense with hyperintense foci on T2-weighted imaging (Fig 2a, 2b). No spinal cord compression was demonstrated. A Tc99m whole body bone scintigram showed increased uptake at the corresponding sites (Fig 2c). The patient underwent a CT-guided biopsy of the T10 lesion for histological diagnosis (Fig 1b). The specimen showed mononuclear cells and multinucleated giant cells. Scanty needle-shaped crystals resembling urate crystals were detected but no malignant cells Thoracic spinal gout mimicking metastasis C A S E R E P O R T