: Case report
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare coexistence of disease or pathologyTrevor Persaud1ABCDEFG, Richard Morgan 1ABCDEFG, Hein Linn Thant1ABCDEFG, Francis J. DeAsis 1ABCDEFG, Felix Ferre1DEFG, Jose Diaz 1BDEF
Am J Case Rep In Press; DOI: :: ID: 936600
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Ankylosing spondylitis (AS) is an immune-mediated chronic inflammatory condition grouped under spondyloarthritis (SpA), which is an umbrella term for a group of interrelated inflammatory rheumatic conditions with characteristic radiographic findings such as erosions and ankylosis of the sacroiliac joint. Unfortunately, there is an average delay of 8-9 years between the onset of the symptoms and diagnosis due to infrequent consideration of this disease in the differential diagnosis of patients with low back pain and unusual or incomplete presenting clinical symptoms.
We describe the case of a 37-year-old male patient with no significant past medical history or surgical history of bilateral hip arthroplasty secondary to idiopathic aseptic necrosis of the bilateral femoral head and bilateral rotator cuff repaired surgery due to multiple motor vehicle accidents (MVA) with a chief concern of chronic low back pain. In this case of ankylosing spondylitis presenting with low back pain and radicular symptoms, his symptoms were resistant to multiple opioid medications, trigger point injections, and epidural steroid injections. Initiation of adalimumab subsequently relieved the patient’s symptoms and restored his ability to perform daily activities.
This is an unusual presentation of AS with radiographic evidence of bilateral sacroiliitis. The neurological manifestations in AS are not uncommon, and they can occur during the quiescent stage of the disease. It should be emphasized that early diagnosis is essential to prevent progression of the disease and avoid unnecessary treatment for the patient.
Keywords: Adalimumab; HLA-B27 Antigen; Radiculopathy; Sacroiliitis; Spondylitis, Ankylosing
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