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Tophaceous lumbar gout mimicking an epidural abscess

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    On general physical examination, a significant proportion of patients were found to have evidence of peripheral tophi (20 cases with tophi vs 6 without, the rest not mentioned). At least 8 cases, including ours, had fever [4,7,9,16,18,22,34]. Serum uric acid levels were often elevated (48 cases elevated vs 13 normal, 13 not reported).

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    Although fever may occur with tumors, a neoplasm is unlikely to spread between vertebrae and to the disk space and surrounding soft tissue, as occurred in this patient. A few reports have shown that gout can mimic epidural infection,1–4 but that process would be more localized. Vasculitis can cause elevated temperatures and levels of inflammatory markers but not the anatomical abnormalities present in this case.

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