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Acute Gouty Sacroiliitis 2003

Rosioreanu A, Flieder A, Ortiz O, Chernoff M, Solomon N
Winthrop-University Hospital
Mineola, NY

A 48-year-old male presented with acute severe back pain and was unable to bear weight on his left leg. Past medical history was significant for infantile poliomyelitis with disuse atrophy of his right lower extremity. Clinical evaluation revealed swelling of his left foot and elbow. A PPD skin test was negative. Laboratory tests revealed a urine uric acid of 1231 mg/24h and an erythrocyte sedimentation rate of 37 mm/hr. The patient’s foot and elbow swelling resolved following treatment with Colchicine. However, his left-sided lower back pain persisted and a bone scan showed increased radiotracer uptake in the left sacroiliac joint that was suspicious for infection.

Contrast-enhanced MRI of the lumbar spine showed low signal on T1 and T2-weighted sequences and abnormal enhancement within the left sacroiliac joint. A biopsy of this joint was requested to assess for possible joint infection. Subtle juxtaarticular erosions were noted on the CT scan that was performed during the biopsy. The biopsy specimen showed foci of acute inflammation with no evidence of infection or neoplasm. Microbiologic analysis showed no evidence of infection. Unilateral sacroiliac joint involvement by acute gout is an uncommon presentation of this disease that can mimic an infectious process within the sacroiliac joint.

References:

1. Resnick CS, Resnick D: Radiology of Disorders of the Sacroiliac Joints, JAMA 1985; 253:2863-2866
2. Bastani B, Vemuri R, Gennis M: Acute Gouty Sacroiliitis: A Case Report and Review of the Literature, Mt Sinai J Med 1997; 64:383-385