The 26-year-old male's spinal lesions were unable to walk and were diagnosed with "gout" after surgery.

A 26 year old male was admitted to the emergency department because he was unable to walk. He underwent surgery the next day after admission. The cause of the disease was confirmed by postoperative pathology. What do you think is the most likely diagnosis? Let's challenge today's Fengbang. The patient is a 26 year old male. He developed weakness in his right lower limb one month ago and failed to see a doctor in time. He gradually developed to weakness of both lower limbs accompanied with numbness in the front and inner side of his left thigh. He was unable to walk one day ago, so he was admitted to the emergency department.the patient's past physical health, personal history and family history were not special.physical examination on admission found that the muscle strength of both lower limbs was IV grade, and knee hyperreflexia.thoracic MR (see Figure 1) showed epidural space occupying lesions extending from T6 to T8, adjacent spinal canal stenosis and spinal cord compression edema.CT (see Figure 2) showed that there were dissolved and erosive lesions around the facet joints of T6 ~ T7 to T8 ~ T9, and the paraarticular substances were lobulated and high density, and extended to the adjacent spinal canal.Figure 1: thoracic MRI (middle thoracic epidural lesions with spinal cord compression) Figure 2: CT (thoracic facet joint lesions) on the second day of admission, the patient underwent t6-t9 laminectomy, resection of epidural mass and pedicle screw fixation (see figure 3).during the operation, "white and cheese like" substance was found in the lesion site, which caused the substantial compression of dura mater.Figure 3 on the first day after X-ray surgery, the muscle strength of both lower limbs of the patient recovered, and the numbness of the skin of the left thigh improved.the "white and cheese like" substance seen during the operation was similar to the sand like deposition in the facet joint caused by gout. Pathological examination showed white like linear crystals with inflammatory cells, including foreign body giant cells, and needle like sodium urate crystals with negative birefringence under polarized light microscope.so.the correct answer is spinal gout.postoperative examinations revealed elevated serum uric acid levels, and X-ray examination of the right hand showed synovitis.patients started taking colchicine 0.6 mg bid and allopurinol 200 mg QD.the patient was discharged from the hospital 6 days later and was followed up for 1 year postoperatively.summary of the case, the patient was a young male. He was admitted to the emergency department because he was unable to walk. Physical examination of nervous system was abnormal. MR showed epidural lesions in thoracic vertebrae and CT showed destruction of facet joints.the patients underwent laminectomy. Needle like sodium urate crystals were confirmed by pathology, and the final diagnosis was spinal gout.the initial symptoms of young gout patients rarely involve the spine. This patient has no history of hyperuricemia and gout, so it is difficult to diagnose at first. related knowledge of spinal gout, to understand ~ gout is a kind of crystal related arthritis caused by monosodium urate deposition, which is directly related to purine metabolism disorder and (or) uric acid excretion reduction caused by hyperuricemia. 95% of gout occurs in men. The onset of gout is generally after the age of 40, and the prevalence rate increases with age, but there is a trend of younger in recent years. the first attack of gout often involves one joint, more than 50% of which occurs in the first metatarsophalangeal joint, and the joints of the dorsum of foot, heel, ankle and knee can also be involved. with the progress of the disease, the number of involved joints can gradually increase, from the lower limb to the upper limb, from the distal small joint to the large joint, and the finger, wrist, elbow and other joints are involved. A few patients can affect the shoulder, hip, sacroiliac, sternoclavicular or spinal joints. spinal gout is rarely the first manifestation of gout, especially in young people. domestic gout compass does not describe spinal gout in detail. in 1950, kersley and others reported spinal gout for the first time. spinal gout is a kind of crystal related arthropathy in which urate crystals are deposited in the spinal joints. It is relatively rare in clinical practice. It can occur in the cervical spine, thoracic spine and lumbar spine, and can be accompanied with or without gout around the joints. some gout patients may have long-term back pain and neurological dysfunction, which may be the first symptom. some patients may also have spinal pain, fever and other symptoms. due to the diversity of clinical manifestations, low positive detection rate of imaging examination and no specificity, early diagnosis and treatment is difficult, and it is easy to be confused with other intraspinal epidural space occupying lesions. the gold standard for the diagnosis of spinal gout is histopathological examination. toprover et al. Conducted a retrospective study of 131 patients with spinal gout. The results showed that gout affected lumbar spine (38%), cervical spine (24.8%) and thoracic spine (17.8%). the most common clinical manifestation is usually back pain, however, more severe neurological symptoms, such as acute paraplegia, may occur. for patients with spinal cord compression symptoms, operation should be carried out as soon as possible to relieve the compression symptoms, improve nerve function and reduce nerve injury. after admission, the patient underwent decompression in time to relieve the symptoms of nervous system and identify the cause. The neurological function recovered well after operation. therefore, if patients with spinal cord compression symptoms have a history of gout or hyperuricemia, especially the presence of gout stones in subcutaneous or other parts, it is necessary to consider the possibility of the disease and attach importance to multidisciplinary cooperation. < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / < br / References: [1] Akhter as, moheldin a, grossbach, AJ: Akhter as, moheldin a, grossbach, 2018: 2018: bcr22017-221163. [3] topriver m, m, t [3] topriver m, toprover m, m, dharki krasnokutsky S. Pillinger MH. Gout in the spine: imaging, diagnosis, and outcomes. Curr rheumatol rep 2015; 17:70. [4] Chinese society of rheumatology. Guidelines for diagnosis and treatment of primary gout [J]. Chinese Journal of Rheumatology, 2011, 15 (6): 410-413