Unusual Cause of Cord Compression in a Patient with Chronic Lymphocytic Leukemia

Spinal gout, though not extremely common, can cause myelopathy due to cord compression. This case is unique because the patient had spinal gout in the thoracic spine and had never been diagnosed with gout or hyperuricemia. A 65-year-old man with chronic lymphocytic leukemia developed rapid weakness in his lower extremities, leading to paraplegia. Imaging revealed severe central canal stenosis and a mass. Biopsy showed tophaceous gout. Despite treatment, the patient did not recover neurologically due to the delay in diagnosis. This highlights the need for early diagnosis and treatment of gout to prevent severe complications.

• 1
  The patient presented with rapid and progressive weakness of the lower extremities leading to complete paraplegia over 2 weeks.
• 2
  Magnetic resonance imaging showed severe central canal stenosis with disc protrusion and a T4-5 ventral mass with abnormal marrow signaling.
• 3
  Biopsy specimen demonstrated fragments of benign cartilage and bone and multiple granulomas palisading around areas of crystalline material, consistent with tophaceous gout.