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 Table of Contents  
IMAGES IN RHEUMATOLOGY
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 247-248

Spondylodiscitis in ankylosing spondylitis: Andersson lesion


1 Department of Rheumatology, Apollo BGS Hospital, Mysuru, Karnataka, India
2 Department of Internal Medicine, Apollo BGS Hospital, Mysuru, Karnataka, India

Date of Web Publication3-Sep-2020

Correspondence Address:
Dr. B N Shiva Prasad
Apollo BGS Hospital, Mysuru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injr.injr_96_20

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  Abstract 


Keywords: Andersson lesion, ankylosing spondylitis, antitumor necrosis factor agent


How to cite this article:
Shiva Prasad B N, Karthik Urala H A. Spondylodiscitis in ankylosing spondylitis: Andersson lesion. Indian J Rheumatol 2020;15:247-8

How to cite this URL:
Shiva Prasad B N, Karthik Urala H A. Spondylodiscitis in ankylosing spondylitis: Andersson lesion. Indian J Rheumatol [serial online] 2020 [cited 2020 Nov 30];15:247-8. Available from: https://www.indianjrheumatol.com/text.asp?2020/15/3/247/287294




  Case Report Top


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 1: Magnetic resonance imaging revealing chronic sacroiliitis

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Figure 2: Magnetic resonance imaging revealing D10–11 disc T2 hyperintensity with abnormal signal in adjacent vertebral corpus

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  Discussion Top


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.[1] The prevalence ranges from 1.5% to over 28%.[2] 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.[2] There are previous radiological descriptions of AL from India.[3] Treatment of this condition has not been defined. Antitumor necrosis factor agents have been useful in control of symptoms and clearance of the lesions.[4]


  Conclusion Top


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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Andersson O. Rontgenbilden vid spondylarthritis ankylopoetica. Nord Med 1937;14:2000-2.  Back to cited text no. 1
    
2.
Bron JL, de Vries MK, Snieders MN, van der Horst-Bruinsma IE, van Royen BJ. Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol 2009;28:883-92.  Back to cited text no. 2
    
3.
Manimegalai N, KrishnanKutty K, Panchapakesa Rajendran C, Rukmangatharajan S, Rajeswari S. Andersson lesion in Ankylosing Spondylitis. JK Sci 2004;6:98-1.  Back to cited text no. 3
    
4.
Joshi N, Nautiyal A, Walton T. Infliximab therapy for inflammatory discitis in ankylosing spondylitis. J Clin Rheumatol 2012;18:109-10.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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