Tophaceous gout masquerading as lumbar disc herniation: Case report

Abstract

Background: Spinal gout is a rare condition that frequently mimics common spinal disorders such as lumbar disc herniation, leading to diagnostic challenges and misdiagnosis. We report a case of spinal gout presenting as lumbar radiculopathy, ultimately confirmed through histopathological analysis. Case: A 66-year-old man with a known history of gout and hypertension came to the hospital with a right L5 radiculopathy and right ankle dorsiflexion weakness graded as 3/5. Magnetic resonance imaging suggested a right paracentral disc herniation with nerve root compression. The patient underwent surgical decompression and spinal stabilization, during which abnormal tissue was excised and submitted for pathological examination. Results: Histopathological analysis confirmed the diagnosis of gouty tophus. Following surgery, the patient experienced rapid symptomatic relief. His motor strength improved significantly to 5/5 at the two-week followup, and he regained full independent mobility without recurrence. Conclusion: Clinicians should consider spinal gout in the differential diagnosis of lumbar radiculopathy, particularly in patients with a history of gout, as histopathological confirmation is essential for accurate diagnosis and effective management.