Title : Reporting a case of ankylosing spondylitis — a condition to be differentiated from infectious diseases
Abstract:
Introduction: Ankylosing spondylitis (AS) is a long-term (chronic) disease. The spine, or other areas of the body, become inflamed, causing part of the spinal column to fuse and lose flexibility (ankylosis). AS affects 1 in 200 individuals and is usually diagnosed many years after symptom onset. Chronic back pain is common, and early recognition of the disease requires clinical experience and good knowledge of the pathology. Moreover, inflammatory markers are not always elevated, and radiographic changes are often late findings.
Objective: The aim of this study is to present the case of a patient who was consulted by infectious disease specialists for intermittent fever associated with severe leg and back pain.
Methods: This paper describes a 41-year-old female, initials R.H., who for months had been experiencing intermittent fever up to 38°C, treated with antipyretics such as paracetamol and ibuprofen. She complained of severe pain at the scapulohumeral level, vertebral column, knees, and legs. Schober’s test was positive. She reported difficulty performing daily activities. Small painful ulcers were noted on the oral mucosa and in the genital region for several days. She complained of visual disturbances and burning sensation in the eyes. She had previously been treated with triple therapy for Helicobacter pylori. She consulted an infectious disease specialist who ordered a panel of laboratory tests, suspecting a Toxoplasma gondii infection, considering that the patient owned a cat. The results showed a high IgG titer for toxoplasmosis, indicating past exposure and ruling out an acute current infection. The patient presented to our consultation center and was admitted for further diagnostic evaluation. She was started on 1 ampoule of prednisolone 25 mg/2 ml intramuscularly daily, and laboratory investigations were performed.Findings included:
- WBC = 10.6 K/µL (slightly elevated)
- LDH = 237 U/L (slightly elevated)
- ANA, ENA screen + profile: negative
- Abdominal CT with contrast showed no pathological findings except a lymph node in the inguinal region measuring 18 mm, similar to the CT scan dated 01/03/2022.
After several days of improvement with treatment, HLA-B27 tested positive, a result that strongly supports the suspicion of Ankylosing Spondylitis.
Results: The diagnosis of ankylosing spondylitis (AS) requires a combination of symptoms, laboratory tests, and imaging findings. The main criteria include: at least three months of inflammatory back pain that improves with physical exercise, morning spinal stiffness, psoriasis, inflammatory bowel disease, uveitis, sacroiliitis on X-ray or MRI, previous infection, and positive HLA-B27. The patient fulfilled the criteria for the diagnosis of Ankylosing Spondylitis.
It was decided to initiate treatment with the biologic agent secukinumab, an IL-17A inhibitor, and the patient was advised to have follow-up visits every two months to assess treatment outcomes.
