SHM Converge Scientific Abstract ePoster Gallery-I Can't Walk: A Delayed Diagnosis of Ankylosing Spondylitis

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This case report describes a 29-year-old African American man with chronic low back pain who developed sudden, severe back pain and became unable to bear weight or walk. He had previously been treated at urgent care for presumed muscular back pain and was discharged without spinal imaging.<br /><br />On examination, he had no focal neurologic deficits. MRI of the thoracic and lumbar spine showed endplate marrow edema and multifocal enhancement involving vertebral bodies, intervertebral discs, epidural space, and paraspinal soft tissue. X-ray of the lumbosacral spine revealed diffuse bilateral sacroiliac sclerosis consistent with sacroiliitis. He was found to be HLA-B27 positive, confirming the diagnosis of ankylosing spondylitis.<br /><br />Initial management included ibuprofen and outpatient referral to rheumatology, pain management, and physical therapy. Early outpatient treatment did not help significantly, but after starting adalimumab, he had marked improvement in pain and regained the ability to ambulate without a walker.<br /><br />The report highlights that ankylosing spondylitis usually presents as chronic low back pain, but delayed recognition can lead to severe complications, including pseudoarthrosis and paraplegia. Although it is more commonly reported in Caucasian and Asian populations, it may also occur in Black patients and may be underdiagnosed due to misattribution of symptoms to muscle strain. The authors stress the importance of maintaining a broad differential diagnosis and having a low threshold for imaging in young adults with back pain, especially when symptoms are severe or disabling.

Asset Subtitle

Taimur Bayar-Masood

Meta Tag

Author List Lawrence Ward, Taimur Bayar-Masood, Yvan Maque-Acosta

Category Clinical Vignettes

Concept Ankylosing Spondylitis

Concept Sacroiliitis

Concept Low Back Pain

Concept HLA-B27

Concept NSAID

Distinguished Non-Finalist

Presenter Organization Bayhealth Medical Center

Presenting Author Taimur Bayar-Masood

Track Adult

Keywords

ankylosing spondylitis

chronic low back pain

sacroiliitis

HLA-B27 positive

MRI spine

epidural enhancement

paraspinal soft tissue

adalimumab

young adult back pain

delayed diagnosis

Ankylosing Spondylitis

Sacroiliitis

Low Back Pain

HLA-B27

NSAID