Case 39 of the ASAS Online Case Library // Demonstration by Denis Poddubnyy and Kay G. Hermann

A 62-year-old man initially presented in the neurosurgery department 1.5 years ago with severe, sudden-onset cervical and thoracic spine back pain, particularly at night, with some improvement with exercise. The CRP level was slightly elevated at a maximum of 16.1 mg/l. A discectomy with cage insertion and anterior spinal fusion at levels C5/6 was performed. No pathogens were detected in the surgical material or biopsy samples.
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In brief, this is a case of "atypical" axial spondyloarthritis.
This case involves "atypical" axial spondyloarthritis that began at the age of 60, predominantly affecting the spine rather than the sacroiliac joints.
The significant inflammation initially led to a misdiagnosis of infectious spondylodiscitis; however, no bacterial or mycobacterial agents were found. The ongoing inflammation, without evidence of active infection, pointed to a potential immune-mediated cause.
The imaging showed extensive spondylitis and non-infectious spondylodiscitis without significant sacroiliac joint involvement, which resembles psoriatic disease or SAPHO / chronic nonbacterial osteomyelitis (CNO). Still, there was neither psoriasis nor a family history nor any other manifestations of SAPHO. HLA-B27 was negative.
Given the diagnosis of axial spondyloarthritis and the insufficient response to NSAIDs, bDMARD therapy was initiated, specifically an IL-17 inhibitor, chosen over a TNF inhibitor due to a history of tuberculosis in childhood. This treatment led to rapid improvement in symptoms and inflammation in the spine.
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#spondyloarthritis #elearning #sacroiliacjoint #reactivearthritis

[@naseerchoh6295]

Excellent presentation

[@Mvega1192]

Fantastic case and very challenging. Great to have your insights

[@berlincaseviewer]

Thanks, Miguel! We are also ready to include one of your cases if you would like.

[@mahdou5097]

❤ aus Neubrandenburg