A Young Man with Axial Spondyloarthritis-like Symptoms Likely Induced by Monosodium Urate Deposition on the Upper Thoracic Vertebrae

抄録

Spinal gout is a rare clinical presentation of gout; its diagnosis is challenging. Dual-energy CT (DECT) enables the detection of monosodium urate (MSU) deposition in the spine as well as in the extremities. A young man with hyperuricemia and no history of gout complained of pain around his sternum, which worsened during work. DECT revealed significant MSU deposition around his first thoracic vertebra as compared to the spine of a patient with severe hyperuricemia, as well as multiple tophi in the extremities. His hyperuricemia was caused by a decrease in the urinary excretion of uric acid. The patient was then treated with a selective urate resorption inhibitor (SURI), dotinurad. His serum uric acid level was within normal limits, and MSU deposition was reduced as observed on DECT images after six months. Treatment with the SURI reduced MSU deposition in the vertebrae, as confirmed on DECT images, as well as serum uric acid levels.