Nonspecific osteomyelitis of the spine (NOS) in a patient with primary gout due to Lesch–Nyhan syndrome (LNS): case description and literature review

Abstract

Introduction Lesions of the spine due to gout are rare types of seronegative spondyloarthritis. The article provides a review of the literature of primary and secondary types of gouty spondyloaritritis and presents a clinical example of nonspecific osteomyelitis of the spine (NOS) in a patient with the primary Lesh-Nyhan syndrome (LNS). The aim of the work is to show the complexity of diagnosis and treatment of pyogenic spondylitis in a patient with a genetically predetermined primary gout LNS. Materials and methods Clinical and radiographic assessment of the patient was performed in accordance with the clinical recommendations for the treatment of infectious spondylitis (2018). The effect of surgical treatment was studied with standard scales and questionnaires: ODI, SF-36, VAS, ASIA. Results Due to pain, severe neurological manifestations and instability of the spine, the patient underwent a decompression stabilizing surgery. The final diagnosis of gout tophus lesions of the spine was established with light polarization microscopy. Conclusion Diagnosis and treatment of gout spondyloarthritis is difficult. The clinical case of NOS in a patient with LNS showed that a diagnostic error and incorrect interpretation of the diagnosis may occur if the postoperative material is not verified histologically and bacteriologically. Since radiographic changes in the spine are usually nonspecific in gout, trepanation biopsy and examination of the histological material with polarizing light are necessary to verify the diagnosis.

Keywords

• gout
• lesh-nyhan syndrome
• spondylitis
• spondyloarthritis
• surgical treatment