Inflammatory Back Pain In A College Gymnast: A Joint Effort

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Inflammatory Back Pain In A College Gymnast: A Joint Effort - Page #3

Lab Studies: HLA B-27 test was initially indeterminate. The test later turned positive on repeat testing two months later. She had a positive sedimentation rate of 42, Negative anti-nuclear antibody (ANA) screen, Cyclin Citrullinated Peptide (CCP), and Rheumatoid Factor. Her comprehensive metabolic panel and complete blood count were unremarkable. Other Studies: X-ray of the lumbar spine showed erosion at the right sacroiliac (SI) joint Case Photo #1 . X-ray of the cervical spine was unremarkable. MR of the Lumbar spine showed mild degenerative changes of the lumbar spine Case Photo #2 , a small central disc protrusion containing an annular fissure w/o stenosis Case Photo #3 Case Photo #4 , and mild interspinous ligament edema at L4-5, L5-S1. There was no high-grade spinal canal or foraminal narrowing. MRI of the Pelvis without contrast showed marked right sacroiliitis w/ erosions, joint widening, and pronounced bone marrow edema with mild L sacroiliitis. The study also showed a mild stress reaction versus inflammation of the pubic symphysis. Case Photo #5 Case Photo #6 Consultations: Rheumatology was consulted and felt this presentation was consistent with ankylosing spondylitis. Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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