We present a 35-year-old male, who initially complained of progressive and persistent inflammatory back pain for 2 years, which was diagnosed as a T12 thoracic spine osteoid osteoma. The patient underwent intralesional resection of the tumor via a posterior approach, with immediate post-operative pain relief, and 2 years of pain-free spine interval. Recently, the patient presented with an inflammatory back pain. Visual Analogic Scale (V.A.S) was 7/10 and stiffness,The Back Pain Functional Scale (BPFS) was 30/60, suggesting a recurrence of the spinal Osteoid Osteoma (OO), diagnosis ruled out giving the negativity of the spine MRI and CT scan. Therefore, an ankylosing spondylitis was suspected, hence, sacroiliac joints MRI was performed, depicting an active bilateral sacroiliitis, confirming the diagnosis of AS according to ASAS criteria. The aim of this paper is to point out similarities between OO and AS and their clinical and probable therapeutic implications. Though few cases of their association have been reported in the literature, both of bone osteoblastic tumors and Ankylosing Spondylitis (AS) share a number of common features, which let us assuming a possible relationship and therefore, the necessity to assess for sacroiliitis in patients with osteoid osteoma. Differential diagnosis should be considered especially in patients with inflammatory back pain. Moreover, a purely pharmacological approach to the management of OO by the use of biological agents may be considered.
We report a case of a 55-year-old female, with 3 years history of a treatment-naive sarcoidosis involving lungs with second-stage sarcoidosis, skin in form of lupus pernio, and bones with multiple cystic areas of the digital bones, soft tissue swelling, nails dystrophy and missed phalanges. Uveitis frequently associated with bone sarcoidosis, was absent in our patient. Prior to attend to our clinic, she had been treated with short courses of nonsteroidal anti-inflammatory drugs and analgesics. No long-term corticosteroids therapy had been reported. Osseous lesions led to autoamputation of distal phalanges of two fingers. It is a very rare complication of unclear mechanism; however, they have been attributed by Several authors to long-term corticosteroid therapy, hypothesis not supported by our findings. Systemic corticosteroids are considered as standard medication. There are no firm guidelines for dosage and period of the treatment. Steroidsparing agents are often added mainly methotrexate, in some patients, biologics can be considered. Unfortunately for our patient, there was not enough time for management as she died lately
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