Spondyloarthritis: A Gouty Display

Abstract

Gout is a systemic, metabolic disease that typically affects the peripheral joints. We describe an unusual presentation of gout affecting the facet joints and costovertebral joints in the thoracic and lumbar spine. A 54-year old man presents to the emergency department with increasing swelling and pain at the left elbow for one week and difficulty ambulating.  The imaging work-up included plain radiographs of the left elbow, left wrist, and chest with subsequent admission for possible septic arthritis. MRI of the elbow showed olecranon bursitis and an erosion  of the lateral epicondyle. CT scan demonstrated lytic cloud-like lesions localized to the facet joints and costovertebral joints of the thoracic and lumbar spine as well as bilateral medullary nephrocalcinosis. Possible hyperparathyroidism manifestations (including Brown tumors and medullary nephrocalcinosis) were evaluated with plains films of the hands; x-rays instead showed classic gouty arthritis. Our report reviews the disease, epidemiology, classic radiologic findings, and treatment of gout.