Destructive spondyloarthropathy mimicking spondylitis in long-term hemodialysis patients.
A 63-year-old man with end-stage renal disease (ESRD) who had been undergoing hemodialysis for 18 years suffered persistent neck pain, progressive quadriparesis, and a deteriorating ataxic gait during the 6 months before admission. A sudden onset of aggravating quadriparesis and an inability to ambulate occurred during his trip to Sydney, Australia, 1 week before this admission. Vertebral tuberculosis osteomyelitis of the C5/6 segment was considered and treated in a hospital there. Findings from cervical magnetic resonance imaging (MRI; low signal intensity on both T1- and T2-weighted images) were diagnostic of destructive spondyloarthropathy (DSA) and distinguishable from spinal osteomyelitis preoperatively. Amyloid masses, mainly composed of B-2 microglobulin, filled in disc and paradiscal ligaments, with adjacent end-plate destruction by cytokine-mediated reactive inflammation, and appeared to be mostly related to the pathogenesis of DSA. The cervical spine, especially C5/6, is the most common site of DSA. Spinal instability and neurologic compression cause the clinical symptoms and signs. Adequate decompression and successful cervical fusion ensure the best therapeutic results.
Niu
C C
CC
Department of Orthopaedics, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan. ccniu@tpts7.seed.net.tw
Chen
W J
WJ
Chen
L H
LH
Shih
C H
CH
D002574:Cervical Vertebrae; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D013117:Spinal Cord Compression / Q000209:etiology*; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D013166:Spondylitis / Q000175:diagnosis*; D013997:Time Factors; D014057:Tomography, X-Ray Computed