title: Vertebral sarcoid mimicking ankylosing spondylitis or just a co-incidence?
abstract: OBJECTIVE
  To illustrate that among the protean musculoskeletal manifestations of sarcoidosis back pain that could mimic inflammatory back pain of ankylosing spondylitis (AS), should also be considered.
  
  
  METHODS
  A case report of a HLA B27 negative patient with classical features of inflammatory back pain that was initially diagnosed as AS is being presented. He showed poor response to standard treatment with nonsteroidal anti-inflammatory drugs and physiotherapy exercises with increasing symptoms of pain, stiffness and development of typical posture of AS. Spine and sacroiliac joint imaging showed progressive features of AS. He was considered a candidate for tumour necrosis factor-alpha inhibitor (iTNF-alpha) infliximab therapy and, therefore, screened for latent tuberculosis using Mantoux test (MT), QuantiFerron-TB Gold (QTG) test and imaging of the chest. Although MT and QTG were negative, contrast-enhanced computerised tomography (CE-CT) of the thorax showed significant hilar and mediastinal lymph nodes (LN).
  
  
  RESULTS
  Biopsy of the mediastinal LN showed non-caseating granulomas typical of sarcoidosis. He was then given infliximab to which he responded dramatically.
  
  
  CONCLUSIONS
  The question remains whether he is a patient with vertebral sarcoidosis or it is a simple coincidence of two unrelated diseases appearing togeth r in this person.
authors.affiliation: A&R Clinic for Arthritis and Rheumatism, Indian Spinal Injuries Centre Superspeciality Hospital, Vasant Kunj, New Delhi-110 070, India.
authors.forename: Anand Narayan
authors.initials: AN
authors.lastname: Malaviya
authors.forename: Sujata
authors.initials: S
authors.lastname: Sawhney
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Kapoor
authors.forename: Sriram
authors.initials: S
authors.lastname: Garg
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001706:Biopsy; D003937:Diagnosis, Differential; D006801:Humans; D000069285:Infliximab; D008279:Magnetic Resonance Imaging; D008297:Male; D012446:Sacroiliac Joint / Q000473:pathology*; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013131:Spine / Q000473:pathology*; D013167:Spondylitis, Ankylosing / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab