title: Gouty arthritis of the spine in a renal transplant patient: a clinical case report: an unusual presentation of a common disorder.
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.
authors.affiliation: From the Renal Division, Department of Internal Medicine (SD, MS, HVDM, SVL), Ghent University Hospital, Ghent, and Department of Nephrology and General Internal Medicine, Jan Yperman Hospital (WT), Ypres, Belgium.
authors.forename: Sofie
authors.initials: S
authors.lastname: Dhaese
authors.forename: Marijke
authors.initials: M
authors.lastname: Stryckers
authors.forename: Hans
authors.initials: H
authors.lastname: Van Der Meersch
authors.forename: Wim
authors.initials: W
authors.lastname: Terryn
authors.forename: Steven
authors.initials: S
authors.lastname: Van Laecke
mesh_terms: D015210:Arthritis, Gouty / Q000150:complications* / Q000175:diagnosis*; D002097:C-Reactive Protein / Q000032:analysis; D003937:Diagnosis, Differential; D005334:Fever / Q000453:epidemiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology*; D013582:Synovial Fluid / Q000737:chemistry; D014057:Tomography, X-Ray Computed; D014527:Uric Acid / Q000032:analysis
chemical_list: D014527:Uric Acid; D002097:C-Reactive Protein
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