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.
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.
Divisione di Reumatologia, IRCCS Fondazione Policlinico S. Matteo, Università di Pavia, Pz.le Golgi 3, Pavia, PV, 27100, Italy. sara.saramonti@gmail.com.
Sara
S
Monti
Divisione di Reumatologia, IRCCS Fondazione Policlinico S. Matteo, Università di Pavia, Pz.le Golgi 3, Pavia, PV, 27100, Italy.
Nicola
N
Boffini
Divisione di Anatomia Patologica, IRCCS Fondazione Policlinico S. Matteo, Università di Pavia, Pz.le Golgi 3, Pavia, PV, 27100, Italy.
Marco
M
Lucioni
Divisione di Anatomia Patologica, IRCCS Fondazione Policlinico S. Matteo, Università di Pavia, Pz.le Golgi 3, Pavia, PV, 27100, Italy.
Marco
M
Paulli
Divisione di Reumatologia, IRCCS Fondazione Policlinico S. Matteo, Università di Pavia, Pz.le Golgi 3, Pavia, PV, 27100, Italy.
Carlomaurizio
C
Montecucco
Divisione di Reumatologia, IRCCS Fondazione Policlinico S. Matteo, Università di Pavia, Pz.le Golgi 3, Pavia, PV, 27100, Italy.
Roberto
R
Caporali
D001402:B-Lymphocytes / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000473:pathology*; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012446:Sacroiliac Joint / Q000473:pathology*; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D014409:Tumor Necrosis Factor-alpha
Ankylosing spondylitis; Anti-TNF alpha; Lymphoma; Spondylodiscitis