Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Acute Low Back Pain from Coexisting Gout and Tuberculous Spondyloarthropathy

급성 요통을 일으킨 결핵과 통풍이 혼재된 척추관절병증

  • Park, Yung (Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital) ;
  • Ha, Joong Won (Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital) ;
  • Kwon, Ji-Won (Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital) ;
  • Eum, Kwangsik (Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital)
  • 박융 (국민건강보험공단 일산병원 정형외과) ;
  • 하중원 (국민건강보험공단 일산병원 정형외과) ;
  • 권지원 (국민건강보험공단 일산병원 정형외과) ;
  • 엄광식 (국민건강보험공단 일산병원 정형외과)
  • Received : 2020.02.17
  • Accepted : 2020.09.22
  • Published : 2021.08.30
⟨ Previous Next ⟩

Abstract

A 67-year-old male patient with a history of epididymectomy and anti-tuberculosis treatment for epididymis tuberculosis was admitted for acute low back pain and radiating pain. The patient had no history of gout but showed hyperuricemia and a bone destruction lesion in the facet joint and lamina of the lumbar spine. A histology examination was performed after a computed tomography-guided needle biopsy, and the findings were compatible with gout spondyloarthropathy and tuberculous spondylitis. The acute symptoms improved after conservative treatment for gouty arthritis. When patients with hyperuricemia risk factors, such as taking anti-tuberculosis drugs, complain of acute low back pain, gout spondyloarthropathy should be considered in a differential diagnosis.

부고환 결핵으로 부고환 절제술 및 항결핵제제를 복용중인 67세 남자 환자가 급성 요통 및 방사통을 주소로 내원하였다. 환자는 통풍의 과거력은 없었으나 혈액 검사상 고요산혈증 소견을 보였으며, 요추 후관절 및 후궁 부위의 골 파괴 병변이 관찰되었다. 요추 후관절 부위의 컴퓨터 단층촬영 유도하 바늘 생검을 실시하여 조직학적 검사를 시행한 결과 통풍성 척추관절병증 및 결핵성 척추염이 진단되었다. 환자는 통풍성 관절염에 대한 보존적 치료를 통해 증상은 호전되었다. 항결핵제제 복용 등 고요산혈증 위험을 가진 환자가 급성 요통을 호소하는 경우 통풍성 척추관절병증을 감별진단해야 하겠다.

Keywords

References

  1. Zhang T, Yang F, Li J, Pan Z. Gout of the axial joint-a patient level systemic review. Semin Arthritis Rheum. 2019;48:649-57. https://doi.org/10.1016/j.semarthrit.2018.04.006
  2. Suk KS, Kim KT, Lee JH, Lee SH, Park SW. Gouty spondyloarthropathy in the lumbar spine mimicking pyogenic discitis: a case report. J Korean Orthop Assoc. 2006;41:756-60. https://doi.org/10.4055/jkoa.2006.41.4.756
  3. Moon MS. Tuberculosis of the spine. Controversies and a new challenge. Spine. 1997;22:1791-7. https://doi.org/10.1097/00007632-199708010-00022
  4. Toprover M, Krasnokutsky S, Pillinger MH. Gout in the spine: imaging, diagnosis, and outcomes. Curr Rheumatol Rep. 2015;17:70. https://doi.org/10.1007/s11926-015-0547-7
  5. Hu HJ, Liao MY, Xu LY. Clinical utility of dual-energy CT for gout diagnosis. Clin Imaging. 2015;39:880-5. https://doi.org/10.1016/j.clinimag.2014.12.015
  6. Dalbeth N, Choi HK, Joosten LAB, et al. Gout. Nat Rev Dis Primers. 2019;5:69. https://doi.org/10.1038/s41572-019-0115-y
  7. Pham AQ, Doan A, Andersen M. Pyrazinamide-induced hyperuricemia. P T. 2014;39:695-715.
  8. Barrett K, Miller ML, Wilson JT. Tophaceous gout of the spine mimicking epidural infection: case report and review of the literature. Neurosurgery. 2001;48:1170-2; discussion 1172-3. https://doi.org/10.1097/00006123-200105000-00046
  9. Cho KJ, Oh IS, Ko SM, Kim WH, Kim CS, Park SR. Diagnostic accuracy of percutaneous needle biopsy of vertebral lesions. J Korean Soc Spine Surg. 1999;6:89-95.
  10. Lorenzo JP, Csuka ME, Derfus BA, Gotoff RA, McCarthy GM. Concurrent gout and Mycobacterium tuberculosis arthritis. J Rheumatol. 1997;24:184-6.