腰椎的痛風石痛風偽裝成感染性脊椎炎：病例報告

Tophaceous gout of the lumbar spine mimicking infectious spondylitis: a case report

痛風侵犯脊椎被認為是罕見的併發症。我們報告一例五十五歲男性因為嚴重背痛及反覆高燒到本院就診，而起初被診斷為第三及第四節腰椎感染性或結核性骨髓炎。藥物治療失敗後病人接受手術治療。類似肉芽腫的病兆被發現，病理檢查顯示是痛風石，是故痛風被證實。病人的背痛及發燒在手術後有改善。Allopurinol隨即被建議使用來控制病人的脊椎痛風。由於病人的擅自停藥，其脊椎痛風復發導致他接受另一次手術。我們藉此病例強調脊椎之痛風石會偽裝成感染性脊椎炎。因此，臨床醫師在治療此類病人時應將其列入鑑別診斷中。

Spinal involvement is considered to be a rare complication of gout. We report a case of a 55-year-old man who presented to our hospital with severe back pain and intermittent high fever and was diagnosed initially as pyogenic or tuberculous osteomyelitis over L3-L4. Operation intervention was carried out after pharmaceutical treatment failure. Granuloma-like lesions were disclosed, the pathological examination revealed it’s a tophus, and gout was confirmed. His back pain and fever improved after operation. Allopurinol was then given for the control of his tophaceous gout over spine. Owing to stopping taking medications by himself, his tophi over spine recurred, and he underwent another operation lately. We highlight this case of tophaceous gout involving the spine that mimicked infectious spondylitis. Therefore, the clinicians should list it into the differential diagnosis in treating such patients.