- Indian Rheumatology association
24-year-old male, presented with a history of back pain for 3 years. Pain was worse at night and associated with early morning stiffness of 1 hour. He was detected to be HLA B27 positive. His CRP was elevated (60 mg/L). Had inadequate response to sulfasalazine plus indomethacin. Patient was being considered for biologicals and came for a second opinion. On examination, 2 lumps were visible on the back, which were soft in consistency.
Diagnosis: Tubercular Spine
Answers
Image 1: Image of lumps at the back
Image 2: MRI Spine revealed spondylodiscitis with paravertebral, paraspinal muscle, bilateral psoas and subcutaneous collections.
Patient was treated with ATT and recovered
Key learning point: Rheumatic diseases are diagnosis of exclusion. Always look for alternatives even if HLA B27 or any other marker is positive. Examination is a must in all patients before treatment escalation
