Ruiz-Morales JM, Dorantes-Heredia R, Martínez-Osuna P, Fernández LY, Green-Renner D

Language: Spanish
References: 10
Page: 250-253
PDF size: 304.68 Kb.

ABSTRACT

Background. Spinal tophi have been reported in isolated case reports in the medical literature. Clinical manifestations can range from asymptomatic, to nerve root compression. These tophi have been confused with epidural abscess, discitis or even malignancies. Case report. We presented a case report of a patient with spinal tophi sent to Oncology center with a probable metastatic disease. Man of 56 year old referred to Oncology consultation secondary to lumbar spine lytic lesions. Medical history of hypertension, urolithiasis, rheumatoid arthritis and gout since September 2011. Currently treated with leflunomide, deflazacort, hydroxychloroquine, allopurinol, amlodipine and telmisartan. Secondary to microscopic hematuria an Uro. CT scan revealed staghorn calculus in the right renal pelvis and five calculus in the lower collecting system with minimal ectasia, left renal hypoplasia with small simple cysts; generalized decrease in bone density and multiple expansive lytic lesions, in the posterior arch of the vertebra from T12 to L5. Column magnetic resonance reported metastatic infiltration of facet joints, juxtaposed plates from T12 to L3 and L5-S1 affecting joints and surrounding soft tissues. Relevant laboratory: Hb 12.5 g/dL , ESR 39 mm/h, BUN 17 mg/dL, Cr 1.5 mg/dL, uric acid 7.3 mg/dL, PSA ‹ 2 ng/mL. Because of this, he underwent CT-guided biopsy, the pathology reported gouty tophi with no evidence of malignancy. Conclusion. Spinal tumors should be evaluated holistically to avoid over-treatment.

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