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Vol. 28. Issue 5.
Pages 242-246 (September - October 2017)
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Vol. 28. Issue 5.
Pages 242-246 (September - October 2017)
Caso clínico
Tofo gotoso en la columna lumbar como inicio de gota en un paciente con normouricemia
Tophaceous gout of the lumbar spine in a patient without systemic gout or normouricaemia
Alejandro Lorentea,
Corresponding author
alejandro.lorentegomez@gmail.com

Autor para correspondencia.
, Rafael Lorenteb, Jorge Romeroc
a Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España
b Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Infanta Cristina, Badajoz, España
c Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Badajoz, España
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Resumen

La gota es una alteración metabólica común, clásicamente diagnosticada en articulaciones periféricas. Los tofos gotosos en la columna lumbar son extraordinariamente raros y han sido muy poco descritos en la literatura. Más aun, describimos un caso en el que la columna lumbar fue la localización en la que se inició la enfermedad, presentando el paciente niveles de ácido úrico normales. El siguiente es el caso de un paciente de 52 años con dolor lumbar con clínica ciática izquierda así como hipoestesia en el miembro inferior izquierdo. El ácido úrico se encontraba en niveles dentro de la normalidad. La resonancia magnética y la gammagrafía ósea eran sugestivas de un proceso inflamatorio-infeccioso centrado a nivel de L4. Tras una laminectomía descompresiva a nivel de L4 y L5, el estudio anatomopatológico demostró tejido infiltrado de células plasmáticas maduras con cristales con birrefringencia negativa con luz polarizada compatibles con depósitos de uratos.

Palabras clave:
Tofo gotoso
Columna lumbar
Dolor lumbar
Ciática
Abstract

Gout is a common metabolic disorder typically diagnosed in peripheral joints. Tophaceous deposits in the lumbar spine is a very rare condition with very few cases reported in the literature. We present a case of tophaceous gout that originated in the lumbar spine in a patient with normal uric acid blood levels. The following case report concerns a 52-year-old patient with low back pain, left sciatica and numbness in the left leg. Serum uric acid levels were within normal range. MRI and bone scan images suggested an inflammatory-infectious process focussed at L4. After an L4-L5 decompressive laminectomy, histological examination revealed tissue infiltrated with mature plasma cells with negatively birefringent crystals using polarised light consistent with urate deposits.

Keywords:
Tophaceous gout
Lumbar spine
Low back pain
Sciatica

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