ReviewRheumatology international2026
Axial gout diagnosed by dual-energy CT in a young normouricaemic man with recurrent nephrolithiasis: a case-based review.
Review in Rheumatology international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Axial gout is an underrecognized manifestation of monosodium urate (MSU) crystal deposition and frequently mimics inflammatory, infectious, or mechanical spinal disorders, particularly without overt hyperuricaemia. We report a 29-year-old man with recurrent low back pain for over two years and recurrent nephrolithiasis who had undergone three extracorporeal shock wave lithotripsy sessions with only transient relief. Admission laboratory investigations showed normal serum urate (262 µmol/L, ~ 4.4 mg/dL) but markedly elevated C‑reactive protein (119 mg/L) and erythrocyte sedimentation rate (53 mm/h). Retrospective review of prior hospitalizations for ureteral stones revealed that routine serum urate measurements had never been elevated. Conventional imaging, including plain radiography and non‑contrast computed tomography, was inconclusive. Dual‑energy computed tomography (DECT) revealed MSU deposition in the L4/L5 and L5/S1 facet joints and sacral foramina, supporting the diagnosis of axial gout. The patient was treated with etoricoxib (60 mg daily) and febuxostat (20 mg daily). On telephone follow‑up on 27 May 2026 (the only follow‑up to date), he reported that the J stent had been removed and low back pain had completely resolved without recurrence. A single repeat laboratory test performed locally was reported as normal, though specific values were unavailable. A systematic literature review of 58 eligible articles revealed that the lumbar spine was most frequently involved (≈ 60%), DECT sensitivity ranged from 78% to 100%, and 77.5% of historically reported cases required surgical diagnosis, underscoring the underrecognition of axial gout in non-surgical settings. This case‑based review highlights that axial gout should be considered in young non‑hyperuricaemic patients with persistent axial pain, and that DECT is a valuable non‑invasive diagnostic tool when interpreted alongside clinical and laboratory features.
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