Causes of Misdiagnosis of Atypical Ankylosing Spondylitis
LI Yi
LI Kuimeng
FENG Huicheng
Abstract：Objective To analyze the causes and preventive measures of ankylosing spondylitis(AS)misdiagnosed as lumbar disc herniation(LDH)and rheumatic fever(RF).Methods The case data of 1 patient with AS misdiagnosed as LDH and 1 patient with RF from 2021 to 2023 were retrospectively analyzed.Results A 31-year-old male patient presented with pain in the lower back and right lower extremity accompanied by morning stiffness for 3 months.CT examination of lumbar disc showed mild disc herniation at L4-5 and was initially diagnosed as LDH.Afterwards,low fever appeared,erythrocyte subsidence rate(ESR)and C-reactive protein(CRP)were elevated,human leukocyte antigen B27(HLA-B27)was positive,and CT scan of the sacroiliac joint showed worm-eaten-like changes on the surface of both sacroiliac joints,which was diagnosed AS.One pa-tient was a 16-year-old adolescent who presented with swelling and pain in both ankles and knees for more than 1 year,which was aggravated for more than 1 month.Due to anti-streptolysin"O"test(+),and the complicated symptoms of multiple joint pain,he was diagnosed with RF.The symptoms improved after Benzathine Penicillin injection and recurred after discontinua-tion.MRI examination of posterior sacroiliac joint showed local fusion of bilateral sacroiliac joint surfaces,with elevated ESR and CRP.Based on this,AS was diagnosed after exclusion of RF.The duration of misdiagnosis was 3 months and 14 months re-spectively.After diagnosis,the symptoms of 2 patients disappeared after treatment with Sulfasalazine,Methotrexate,and recombi-nant human tumor necrosis factor receptor type Ⅱ antibody fusion protein.They were followed up for 1 to 2 years,and the con-dition was stable.Conclusion Some patients with AS have atypical manifestations in the early stage and are prone to misdiag-nosis.Strengthening the understanding of AS and related diseases,diagnosis and differential diagnosis ability,careful collec-tion of medical history,careful physical examination,early imaging examination of sacroiliac joint and HLA-B27 detection,com-bined with clinical manifestations and other relevant examination results,can help avoid misdiagnosis of this disease.
Keywords：Ankylosing spondylitisMisdiagnosisIntervertebral disc herniationRheumatic feverHLA-B27Erythro-cyte sedimentation rateDifferential diagnosis
Publication Date：2024-07-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 1-5 )