Atypical presentation of ankylosing spondylitis: a case study

Area of Science:

• Rheumatology
• Radiology
• Immunology

Background:

• Ankylosing spondylitis (Marie Strumpell's disease) is a chronic inflammatory condition primarily impacting the axial skeleton.
• Bilateral sacroiliitis is the earliest radiographic hallmark in 90% of patients.
• A small percentage (up to 3%) may exhibit atypical presentations without initial sacroiliitis.

Observation:

• This report details a patient diagnosed with ankylosing spondylitis presenting atypically.
• The patient's radiographic findings included syndesmophytosis but lacked sacroiliac joint involvement.
• Clinical symptoms, radiographic evidence, and laboratory results supported the diagnosis.

Findings:

• The case demonstrates that syndesmophytosis can be a presenting feature of ankylosing spondylitis, even in the absence of sacroiliitis.
• This challenges the typical diagnostic pathway, emphasizing the need for broader consideration of clinical and radiological signs.
• Diagnosis was confirmed based on a combination of symptoms, imaging, and lab work.

Implications:

• This atypical presentation expands the understanding of ankylosing spondylitis's varied clinical manifestations.
• It underscores the importance of considering diagnoses beyond classic signs, especially when symptoms align.
• Further research may elucidate the mechanisms behind non-sacroiliitic presentations of ankylosing spondylitis.