Severe systemic inflammatory response syndrome immediately after spinal surgery in a patient with axial gout

Abstract

We report a 55-year-old man with gouty arthritis who developed a 3-month history of low back pain, gradual lower extremities weakness and urinary incontinence. Lumbar MRI showed an exophytic lesion at L3-L4. Immediately after spinal decompression surgery, he developed fever, disorientation, polyarthritis, acute kidney injury and leucocytosis. He was treated with multiple antimicrobial agents for presumed spinal abscess but did not improve. Multiple body site cultures were negative. Aspiration of the sacroiliac joint revealed the presence of monosodium uric acid crystals. A diagnosis of acute gout was done, and he was treated with high-dose intravenous methylprednisolone and colchicine. Within 48 hours, he had a remarkable clinical improvement. At discharge, neurological and laboratory abnormalities had resolved. Awareness of risk factors for axial gout and a high degree of suspicion are important to establish a prompt diagnosis and treatment to prevent severe complications as seen in this case.

Postoperative systemic inflammatory response syndrome predicts increased mortality in patients after elective craniotomy

“…To the best of our knowledge, this is the first study of postoperative SIRS in patients who underwent craniotomy. Previous studies (18)(19)(20)(21)(22)(23)(24) have evaluated postoperative SIRS in patients after various types of surgeries and showed that postoperative SIRS was associated with poor outcomes. Moreover, our research sample was larger and focused on noninfectious SIRS, which resulted in a higher predictive value for the perioperative outcome.…”

Gout Storm

“…CRP, ESR, and procalcitonin at high levels as observed in infectious disease have been described during acute gout attacks and chronic gout [ 17 , 18 , 20 , 21 ]. A severe systemic inflammatory response syndrome simulating sepsis has also been observed in acute polyarticular gout [ 22 ] and immediately after spinal surgery for axial gout [ 14 ]. On left-knee ultra-sound, our findings of thick fluid and echogenic debris have low specificity and accuracy for diagnosing gout, but a double contour sign and articular tophus have a high specificity for gout diagnosis [ 23 ].…”

“…Histopathological examination showed tissue fragments with mononuclear inflammatory infiltrate and partially calcified acellular material with giant cells surrounding the amorphous crystalline material, compatible with a gout tophus ( Figure 3 ). Unfortunately, pathology analysis could not show uric acid crystals as the surgical specimen was fixed in formalin, which causes dissolution of uric acid crystals [ 14 , 15 ]. The patient was discharged after improvements in lower-limb paresthesia and left-limb muscle force and remission of fecal and urinary incontinence.…”

Diagnosing Spinal Gout: A Rare Case of Back Pain and Fever

“…Both can present with severe back pain, fever, and elevated acute phase reactants and can have undistinguishable imaging findings. Acute gouty arthritis can present with systemic inflammatory response syndrome (SIRS) and can be misdiagnosed as sepsis [ 10 ]; this finding has also been described in spinal gout [ 11 ]. Janssens et al created a diagnostic tool to differentiate severe gouty arthritis from sepsis in the primary care setting [ 12 ].…”