Spinal gouty tophus presenting as an epidural mass with acute myelopathy

An uncommon case of spinal gouty tophus was diagnosed in a 74-year-old man who presented in the emergency department with sudden onset of acute paraplegia. The patient underwent laminectomy and nodule removal for neurodecompression. After surgery, the patient demonstrated good functional recovery and returned to baseline performance status. Intraspinal tophi are rare. Image study may show irrelevant findings. In patients with gout, the differential diagnosis should include tophi. In the present case, imaging did not reveal much inflammatory change, but severe symptoms were observed, and a definite preoperative diagnosis was difficult. In cases with neurological compromise, timely neurosurgical decompression leads to good outcomes, as in the present case.