History

A 45-year-old female patient with diffuse osteoarticular pain, particularly low back pain, was referred by a rheumatologist for an updated radiologic evaluation. The patient had experienced these symptoms for many years and was diagnosed with human leukocyte antigen B27–negative spondyloarthritis approximately 11 years prior, based on findings of bilateral erosive sacroiliitis at pelvic radiography (Fig 1A) and bone scintigraphy with technetium 99m methylene diphosphonate (Fig 1B). After 3 years of treatment with a tumor necrosis factor–α inhibitor (adalimumab), which was effective for pain, the patient was lost to follow-up.

At the current presentation, approximately 8 years after being lost to follow-up, the patient presented with worsening low back pain. The presence of nonobstructing kidney stones on US images confounded the underlying cause of worsening pain. The patient also experienced fatigue and depressed mood. Routine blood tests revealed a normal blood cell count, creatinine level of 0.64 mg/dL (56.58 μmol/L) (normal range, 0.30–1.1 mg/dL [26.52–97.24 mmol/L]), C-reactive protein level of 1.1 mg/dL (normal, <1 mg/dL), and vitamin D level of 21 ng/mL (52.42 nmol/L) (normal range, 30–100 ng/mL [74.88–249.60 nmol/L]).

Noncontrast MRI of the thoracic and lumbar spine (Fig 2), MRI of the sacroiliac joints (Fig 3), and CT of the abdomen and pelvis (Fig 4) were performed.

中文翻译：

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案例328

历史

一名 45 岁女性患者患有弥漫性骨关节疼痛，尤其是腰痛，风湿病学家将其转介进行更新的放射学评估。该患者多年来一直经历这些症状，并在大约 11 年前被诊断为人类白细胞抗原 B27 阴性脊柱关节炎，基于盆腔 X 线检查（图 1A）和 99m 亚甲基二膦酸锝骨闪烁扫描（图 1B）中发现的双侧糜烂性骶髂关节炎的结果）。肿瘤坏死因子-α 抑制剂（阿达木单抗）对疼痛有效，经过 3 年治疗后，患者失访。

目前，距失访大约 8 年，患者出现腰痛恶化的症状。超声图像上存在的非阻塞性肾结石混淆了疼痛恶化的根本原因。患者还感到疲劳和情绪低落。常规血液检查显示血细胞计数正常，肌酐水平为 0.64 mg/dL (56.58 μmol/L)（正常范围，0.30–1.1 mg/dL [26.52–97.24 mmol/L]），C 反应蛋白水平为 1.1 mg/dL（正常，<1 mg/dL），维生素 D 水平为 21 ng/mL (52.42 nmol/L)（正常范围，30–100 ng/mL [74.88–249.60 nmol/L]）。

进行了胸椎和腰椎的非增强 MRI（图 2）、骶髂关节的 MRI（图 3）以及腹部和骨盆的 CT（图 4）。