Pulmonary involvement in ankylosing spondylitis

Abstract

This is a review of published data on pulmonary manifestations of ankylosing spondylitis (AS) and a case report of 49-year old male suffering from AS with pulmonary involvement. Lung lesions are frequent extra-articular manifestations of AS. There are a variety of pulmonary manifestations in AS, including lesions of the lung parenchyma, the pleura, the airways and ventilation disorders due to sclerosis of the costovertebral joints and ankylosis of the thoracic spine. An incidence of the lung injury in AS patients has increased significantly after implementation of high-resolution computed tomography (CT). Pulmonary apical fibro-bullous changes were found in CT scans. These lesions are common targets for Aspergillus infection. In the present case, bilateral upper lobe cavitating pneumonia was diagnosed in the patient after exclusion of pulmonary tuberculosis. The patient repeatedly received prolonged antibiotic therapy. His condition deteriorated with development of chronic bilateral pulmonary cavitary aspergillosis. This clinical case demonstrates insufficient knowledge of physicians and radiologists on pulmonary involvement in AS. This leads to therapeutic mistakes and the late diagnosis of pulmonary disease.

Apical fibrobullous lung disease in ankylosing spondylitis: case report and literature review

“…AFBD is one of the most recognized pulmonary complications although rare. It was described for the first time in 1941 and better characterized since 1980, with the advent of chest CT [ 2 , 5 ]. It affects predominantly men (ratio 50:1), can be uni-/bilateral, is classically described as having a slow progression, may cavitate and is frequently confounded with pulmonary TB [ 2 ].…”

“…A retrospective evaluation of 2080 patients with AS who performed HRCCT reported apical fibrosis or fibro-cavitary disease in 28 (1.3%) patients [ 10 ]. In another prospective study over a 10-year period, including 1028 patients with AS, 2.1% developed AFBD [ 2 ]. In a systematic review, the prevalence of chest CT anomalies in patients with AS was of 61%, for a mean disease length of 11.7 ± 5.2 years.…”

“…Ankylosing spondylitis (AS) is estimated to affect about 0.1% of the population [ 1 ]. Although its etiology and pathogenesis are not fully understood, it is strongly associated with HLA-B27 (a class 1 histocompatibility antigen), and the prevalence of AS parallels the distribution of HLA-B27 in different populations [ 2 ]. A strong familiar pattern is described and typically disease manifestations arise in the third decade of life, with a higher incidence in young men, 90% of which are HLA-B27 positive [ 1 , 3 ].…”

“…Extra-articular manifestations vary widely in terms of frequency and severity, with descriptions of ocular, cardiovascular, renal, neurological, and pulmonary involvement, among others [ 1 , 4 ]. Pulmonary involvement in AS is frequently a result of chest wall restriction and/or parenchymal disease including some severe and unique lung manifestations such as apical fibrobullous disease (AFBD), with or without cavitation [ 2 ]. Although AS is a common cause of AFBD, the latter is an infrequent extra-spinal complication of AS that requires careful differential evaluation.…”