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Gouty arthritis of the spine in a renal transplant patient : a clinical case report: an unusual presentation of a common disease

(2015) MEDICINE. 94(13).
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Abstract
Axial gout is a well-documented but uncommon manifestation of gout. Its mimicking nature and the impracticality of axial joint aspiration might considerably delay its diagnosis. We report a case in a normouricemic renal transplant recipient, whereby the primary symptom of severe neck pain suggested pyogenic spondylodiscitis as an initial tentative diagnosis. Clinical findings included a high C-reactive protein concentration and elevated body temperature. The patient did not respond to empiric antibiotic treatment and suffered consecutive attacks of severe wrist and ankle pain in conjunction with a persistent fever. Blood and joint cultures were negative, but analysis of aspirated ankle joint fluid revealed monosodium urate crystals. A dual-energy computed tomography scan confirmed the presence of monosodium urate crystals in the costovertebral joints. Colchicine treatment dramatically improved the patient's clinical condition. Axial gout should be considered in transplant recipients with severe neck or back pain, fever, and increased inflammatory parameters with a high likelihood of an infectious etiology, despite the presence of paradoxically normal or even decreased serum urate concentrations. Dual-energy computed tomography is a noninvasive technique of possible benefit in the detection of axial gout when joint fluid aspiration is not deemed safe.
Keywords
SERUM URIC-ACID

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Chicago
Dhaese, Sofie, MARIJKE STRYCKERS, HANS VAN DER MEERSCH, Wim Terryn, and Steven Van Laecke. 2015. “Gouty Arthritis of the Spine in a Renal Transplant Patient : a Clinical Case Report: An Unusual Presentation of a Common Disease.” Medicine 94 (13).
APA
Dhaese, Sofie, STRYCKERS, M., VAN DER MEERSCH, H., Terryn, W., & Van Laecke, S. (2015). Gouty arthritis of the spine in a renal transplant patient : a clinical case report: an unusual presentation of a common disease. MEDICINE, 94(13).
Vancouver
1.
Dhaese S, STRYCKERS M, VAN DER MEERSCH H, Terryn W, Van Laecke S. Gouty arthritis of the spine in a renal transplant patient : a clinical case report: an unusual presentation of a common disease. MEDICINE. 2015;94(13).
MLA
Dhaese, Sofie, MARIJKE STRYCKERS, HANS VAN DER MEERSCH, et al. “Gouty Arthritis of the Spine in a Renal Transplant Patient : a Clinical Case Report: An Unusual Presentation of a Common Disease.” MEDICINE 94.13 (2015): n. pag. Print.
@article{5928487,
  abstract     = {Axial gout is a well-documented but uncommon manifestation of gout. Its mimicking nature and the impracticality of axial joint aspiration might considerably delay its diagnosis. We report a case in a normouricemic renal transplant recipient, whereby the primary symptom of severe neck pain suggested pyogenic spondylodiscitis as an initial tentative diagnosis. Clinical findings included a high C-reactive protein concentration and elevated body temperature. The patient did not respond to empiric antibiotic treatment and suffered consecutive attacks of severe wrist and ankle pain in conjunction with a persistent fever. Blood and joint cultures were negative, but analysis of aspirated ankle joint fluid revealed monosodium urate crystals. A dual-energy computed tomography scan confirmed the presence of monosodium urate crystals in the costovertebral joints. Colchicine treatment dramatically improved the patient's clinical condition. 
Axial gout should be considered in transplant recipients with severe neck or back pain, fever, and increased inflammatory parameters with a high likelihood of an infectious etiology, despite the presence of paradoxically normal or even decreased serum urate concentrations. Dual-energy computed tomography is a noninvasive technique of possible benefit in the detection of axial gout when joint fluid aspiration is not deemed safe.},
  articleno    = {e676},
  author       = {Dhaese, Sofie and STRYCKERS, MARIJKE and VAN DER MEERSCH, HANS and Terryn, Wim and Van Laecke, Steven},
  issn         = {0025-7974},
  journal      = {MEDICINE},
  keywords     = {SERUM URIC-ACID},
  language     = {eng},
  number       = {13},
  pages        = {4},
  title        = {Gouty arthritis of the spine in a renal transplant patient : a clinical case report: an unusual presentation of a common disease},
  url          = {http://dx.doi.org/10.1097/MD.0000000000000676},
  volume       = {94},
  year         = {2015},
}

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