THIS 16 YEAR OLD PRESENTS WITH BILATERAL SACROILIAC PAIN – WHAT’S THE DIAGNOSIS?


Case History


This 16 year old male patient presents with left and right-sided buttock and lumbosacral pain. No history of any surgical intervention. Morning stiffness is noted clinically.


Discussion


Note the significant sclerosis of the mid and lower portion of the sacroiliac joints bilaterally. The articular margins are somewhat instinct characteristic of the appearance of early sacroiliitis which may explain the patient’s presenting signs and symptoms.


The lumbar spine did not show any evidence of ankylosing spondylitis or enteropathic spondylitis. Patients with a history of chronic Crohn’s disease or ulcerative colitis may develop an ankylosing spondylitis radiographic presentation and is usually limited to the sacroiliac joints and lumbar spine seldom progressing above the thoracolumbar junction.


An important radiographic peril is that if the sacroiliac joints appear to be indistinct suggesting sacroiliitis the second most common location for early ankylosing spondylitis is a marginal syndesmophyte at the T12/L1 junction. This was not present in this case.


This patient should be referred to a rheumatologist for complete blood work to include HLAB-27 antigen, ESR, CRP, and a CBC.


Patients can be comanaged with ankylosing spondylitis but there are certain drugs now that can limit the progression of ankylosing spondylitis if found early and managed appropriately. This case came through our chiropractic radiology practice from one of our referring doctors from Alabama. This is a current case at this time. I believe the blood tests will help confirm the diagnosis of ankylosing spondylitis.