|IMAGES IN RHEUMATOLOGY
|Ahead of print publication
Spondylodiscitis in ankylosing spondylitis: Andersson lesion
BN Shiva Prasad1, HA Karthik Urala2
1 Department of Rheumatology, Apollo BGS Hospital, Mysuru, Karnataka, India
2 Department of Internal Medicine, Apollo BGS Hospital, Mysuru, Karnataka, India
BN Shiva Prasad,
Apollo BGS Hospital, Mysuru, Karnataka
Source of Support: None, Conflict of Interest: None
Keywords: Andersson lesion, ankylosing spondylitis, antitumor necrosis factor agent
| Case Report|| |
A 45-year-old man with ankylosing spondylosis (AS) for 15 years on nonsteroidal anti-inflammatory drugs and sulfasalazine (2 g/day) presented with subacute-onset pain over the mid-back region. He had kyphosis with restricted neck movement and tenderness over the mid-thoracic region without a history of trauma. Erythrocyte sedimentation rate was 8 mm/1st h (10–20 mm/h), and C-reactive protein was 2.35 mg/dL (0–6 mg/dl). Magnetic resonance imaging (MRI) spine showed ossification of the anterior longitudinal ligament, shiny corners of the lower dorsal and lumbar vertebrae, and healed inflammatory changes of the bilateral sacroiliac joints [Figure 1]. There was D10-11 disc appeared hyperintense on T2 weighted imaages and hypointense on T1 weighted images with no paraspinal collection, suggestive of noninfective spondylodiscitis – Andersson lesion (AL) [Figure 2]. Blood culture, procalcitonin, Mantoux test, and TB quantiFERON tests were negative. Chest X-ray was normal. He was started with etanercept injection, 50 mg subcutaneous, once weekly, and after 4 weeks, he showed significant improvement in pain and mobility.
|Figure 2: Magnetic resonance imaging revealing D10–11 disc T2 hyperintensity with abnormal signal in adjacent vertebral corpus|
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| Discussion|| |
AL is a well-known complication in patients with AS, characterized by the development of localized vertebral or discovertebral lesions of the spine and described as hemispherical lesions in the body of vertebrae with lines of increased signal intensity may be seen at the interface between the annulus fibrosus and nucleus pulposus or within the latter in early disease. It was first described by Andersson in 1937. The prevalence ranges from 1.5% to over 28%. MRI is the best modality in visualizing AL with the highest sensitivity and specificity. ALs are most commonly among middle-aged males (63%–86%), with longstanding AS. ALs occur at any level; single or multiple levels. There are previous radiological descriptions of AL from India. Treatment of this condition has not been defined. Antitumor necrosis factor agents have been useful in control of symptoms and clearance of the lesions.
| Conclusion|| |
In AS patient presenting with localized vertebral pain, AL should be thought of after ruling out secondary infections.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Andersson O. Rontgenbilden vid spondylarthritis ankylopoetica. Nord Med 1937;14:2000-2.
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[Figure 1], [Figure 2]