Spinal non-Hodgkin’s lymphoma mimicking a flare of disease in a patient with ankylosing spondylitis treated with anti-TNF agents: case report and review of the literature

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

We report the case of a 52-year-old man with long-standing HLAB27-positive ankylosing spondylitis treated with anti-tumour necrosis factor (TNF) alpha therapy who was admitted to our rheumatology department complaining of increasing lumbar and buttock pain radiating to the posterior thigh, associated with numbness in the leg, gait disturbance and low-grade fever. The clinical picture was initially interpreted as a flare of disease but was not responsive to treatment. A contrast-enhanced spinal MRI was performed with evidence of a diffuse signal abnormality involving the sacroiliac joints and the spine, with evidence of spondylodiscitis of L5 and with a lesion causing L5-S1 root compression and infiltrating the iliopsoas muscle. These findings confirmed the possibility of a reactivation of disease associated with an infectious process. The most frequent causes of infectious spondylodiscitis were excluded, and a biopsy was then performed. Histological analysis revealed a high-grade B-cell non-Hodgkin’s lymphoma of the spine. This case highlights how a differential diagnosis of low back pain with neurological symptoms can be particularly troublesome in ankylosing spondylitis and that continuous vigilance is warranted in patients treated with long-term immunosuppressive therapies.

Original languageEnglish
Pages (from-to)275-280
Number of pages6
JournalClinical Rheumatology
Volume35
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

Fingerprint

Ankylosing Spondylitis
Non-Hodgkin's Lymphoma
Discitis
Tumor Necrosis Factor-alpha
Spine
Sacroiliac Joint
Buttocks
Hypesthesia
Rheumatology
B-Cell Lymphoma
Immunosuppressive Agents
Low Back Pain
Thigh
Gait
Leg
Differential Diagnosis
Fever
Therapeutics
Biopsy
Pain

Keywords

  • Ankylosing spondylitis
  • Anti-TNF alpha
  • Lymphoma
  • Spondylodiscitis

ASJC Scopus subject areas

  • Rheumatology

Cite this

@article{5497b306cff0423cba49249c21defa97,
title = "Spinal non-Hodgkin’s lymphoma mimicking a flare of disease in a patient with ankylosing spondylitis treated with anti-TNF agents: case report and review of the literature",
abstract = "We report the case of a 52-year-old man with long-standing HLAB27-positive ankylosing spondylitis treated with anti-tumour necrosis factor (TNF) alpha therapy who was admitted to our rheumatology department complaining of increasing lumbar and buttock pain radiating to the posterior thigh, associated with numbness in the leg, gait disturbance and low-grade fever. The clinical picture was initially interpreted as a flare of disease but was not responsive to treatment. A contrast-enhanced spinal MRI was performed with evidence of a diffuse signal abnormality involving the sacroiliac joints and the spine, with evidence of spondylodiscitis of L5 and with a lesion causing L5-S1 root compression and infiltrating the iliopsoas muscle. These findings confirmed the possibility of a reactivation of disease associated with an infectious process. The most frequent causes of infectious spondylodiscitis were excluded, and a biopsy was then performed. Histological analysis revealed a high-grade B-cell non-Hodgkin’s lymphoma of the spine. This case highlights how a differential diagnosis of low back pain with neurological symptoms can be particularly troublesome in ankylosing spondylitis and that continuous vigilance is warranted in patients treated with long-term immunosuppressive therapies.",
keywords = "Ankylosing spondylitis, Anti-TNF alpha, Lymphoma, Spondylodiscitis",
author = "Sara Monti and Nicola Boffini and Marco Lucioni and Marco Paulli and Carlomaurizio Montecucco and Roberto Caporali",
year = "2016",
month = "1",
day = "1",
doi = "10.1007/s10067-014-2594-2",
language = "English",
volume = "35",
pages = "275--280",
journal = "Clinical Rheumatology",
issn = "0770-3198",
publisher = "Springer London",
number = "1",

}

TY - JOUR

T1 - Spinal non-Hodgkin’s lymphoma mimicking a flare of disease in a patient with ankylosing spondylitis treated with anti-TNF agents

T2 - case report and review of the literature

AU - Monti, Sara

AU - Boffini, Nicola

AU - Lucioni, Marco

AU - Paulli, Marco

AU - Montecucco, Carlomaurizio

AU - Caporali, Roberto

PY - 2016/1/1

Y1 - 2016/1/1

N2 - We report the case of a 52-year-old man with long-standing HLAB27-positive ankylosing spondylitis treated with anti-tumour necrosis factor (TNF) alpha therapy who was admitted to our rheumatology department complaining of increasing lumbar and buttock pain radiating to the posterior thigh, associated with numbness in the leg, gait disturbance and low-grade fever. The clinical picture was initially interpreted as a flare of disease but was not responsive to treatment. A contrast-enhanced spinal MRI was performed with evidence of a diffuse signal abnormality involving the sacroiliac joints and the spine, with evidence of spondylodiscitis of L5 and with a lesion causing L5-S1 root compression and infiltrating the iliopsoas muscle. These findings confirmed the possibility of a reactivation of disease associated with an infectious process. The most frequent causes of infectious spondylodiscitis were excluded, and a biopsy was then performed. Histological analysis revealed a high-grade B-cell non-Hodgkin’s lymphoma of the spine. This case highlights how a differential diagnosis of low back pain with neurological symptoms can be particularly troublesome in ankylosing spondylitis and that continuous vigilance is warranted in patients treated with long-term immunosuppressive therapies.

AB - We report the case of a 52-year-old man with long-standing HLAB27-positive ankylosing spondylitis treated with anti-tumour necrosis factor (TNF) alpha therapy who was admitted to our rheumatology department complaining of increasing lumbar and buttock pain radiating to the posterior thigh, associated with numbness in the leg, gait disturbance and low-grade fever. The clinical picture was initially interpreted as a flare of disease but was not responsive to treatment. A contrast-enhanced spinal MRI was performed with evidence of a diffuse signal abnormality involving the sacroiliac joints and the spine, with evidence of spondylodiscitis of L5 and with a lesion causing L5-S1 root compression and infiltrating the iliopsoas muscle. These findings confirmed the possibility of a reactivation of disease associated with an infectious process. The most frequent causes of infectious spondylodiscitis were excluded, and a biopsy was then performed. Histological analysis revealed a high-grade B-cell non-Hodgkin’s lymphoma of the spine. This case highlights how a differential diagnosis of low back pain with neurological symptoms can be particularly troublesome in ankylosing spondylitis and that continuous vigilance is warranted in patients treated with long-term immunosuppressive therapies.

KW - Ankylosing spondylitis

KW - Anti-TNF alpha

KW - Lymphoma

KW - Spondylodiscitis

UR - http://www.scopus.com/inward/record.url?scp=84954399614&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84954399614&partnerID=8YFLogxK

U2 - 10.1007/s10067-014-2594-2

DO - 10.1007/s10067-014-2594-2

M3 - Article

AN - SCOPUS:84954399614

VL - 35

SP - 275

EP - 280

JO - Clinical Rheumatology

JF - Clinical Rheumatology

SN - 0770-3198

IS - 1

ER -