Adalimumab for recurrent inflammatory discitis associated with spondyloarthropathy

第一作者:Liu Yuhong

2014-06-03 点击量:660   我要说

Liu Yuhong,Mei Chunli,Du Rong,Huang Anbin,Hussen Mansai


To the editor:A 55-year-old woman was admitted to orthopaedics departmentin our hospital with a 3-month history of severe low backache and difficulty in walking in June 2010. Physical examination revealed restricted lumbar spine movement with marked tenderness of lumbar region, but no other joint and extra-articular abnormal features. Blood analysis revealed normal white blood cell count and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), pure protein derivative and rheumatoid factor and antinuclear antibody were all negative, T-spot. Tuberculosis (TB) and human leukocyte antigen-B27 were positive, MRI showed normal sacroiliac joint anddiscitisat L1/2 (Figure 1A). The patient had no a history of other diseases including TB before the start of symptoms except apositive family history of spondyoarthropathy. Since doctors were unable to rule out infectious diseases based on the above data and therefore initiated broad-spectrum antibiotics treatment for 4 weeks and 4-drug anti-TB treatment for 2 months, besides using nonsteroidal anti-inflammatory drugs (NSAIDs) at the same time. However, her symptoms persisted and inflammatory markers remained elevated. She therefore underwent the first surgery.Histological study showed granulomatous inflammation with diffuse infiltration of neutrophils.The patient experienced pain reliefimmediately postoperatively. As TB of lumbar spine could not yet be excluded, she remained on anti-TB treatment despite no backache.


One year after operation, the patient was readmitted to orthopedics department for unbearable thoracolumbar pain, higherESR andCRP, and discitis at T9/10(Figure 1B). Owing to the occurrence of new discitis one year after anti-TB regimen, her diagnosis was presumed to be inflammatory discitis rather than tuberculous discitis. Therefore, the anti-TB regimen was stopped and NSAIDs were prescribed. However, her symptoms were only slightly improved two months after NSAIDs treatment, thus the second surgery was performed.The patient reexperienced pain reliefimmediately postoperatively.

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