Spinal non-Hodgkin's lymphoma mimicking a flare of disease in a patient with ankylosing spondylitis treated with anti-TNF agents: case report and review of the literature

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• 作者：Sara Monti ; Nicola Boffini ; Marco Lucioni ; Marco Paulli…
• 关键词：Ankylosing spondylitis ; Anti ; TNF alpha ; Lymphoma ; Spondylodiscitis
• 刊名：Clinical Rheumatology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：35
• 期：1
• 页码：275-280
• 全文大小：744 KB
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• 作者单位：Sara Monti (1)
  Nicola Boffini (1)
  Marco Lucioni (2)
  Marco Paulli (2)
  Carlomaurizio Montecucco (1)
  Roberto Caporali (1)
  
  1. Divisione di Reumatologia, IRCCS Fondazione Policlinico S. Matteo, Università di Pavia, Pz.le Golgi 3, Pavia, PV, 27100, Italy
  2. Divisione di Anatomia Patologica, IRCCS Fondazione Policlinico S. Matteo, Università di Pavia, Pz.le Golgi 3, Pavia, PV, 27100, Italy
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Rheumatology
  
• 出版者：Springer London
• ISSN：1434-9949

文摘

We report the case of a 52-year-old man with long-standing HLAB27-positive ankylosing spondylitis treated with anti-tumour necrosis factor (TNF) alpha therapy who was admitted to our rheumatology department complaining of increasing lumbar and buttock pain radiating to the posterior thigh, associated with numbness in the leg, gait disturbance and low-grade fever. The clinical picture was initially interpreted as a flare of disease but was not responsive to treatment. A contrast-enhanced spinal MRI was performed with evidence of a diffuse signal abnormality involving the sacroiliac joints and the spine, with evidence of spondylodiscitis of L5 and with a lesion causing L5-S1 root compression and infiltrating the iliopsoas muscle. These findings confirmed the possibility of a reactivation of disease associated with an infectious process. The most frequent causes of infectious spondylodiscitis were excluded, and a biopsy was then performed. Histological analysis revealed a high-grade B-cell non-Hodgkin’s lymphoma of the spine. This case highlights how a differential diagnosis of low back pain with neurological symptoms can be particularly troublesome in ankylosing spondylitis and that continuous vigilance is warranted in patients treated with long-term immunosuppressive therapies.