Disclosures: Austin J. Wang, BA: No financial relationships or conflicts of interest

Case Diagnosis: A 45-year-old male with discoid psoriasis presenting with progressive low back pain was diagnosed with psoriatic spondylodiscitis by diagnosis of exclusion.

Case Description or Program Description: We present a case of a 45-year-old male with a history of discoid psoriasis, who initially presented at a pain management clinic for worsening low back pain. The patient was prescribed analgesics and underwent physical therapy and two fluoroscopic guided epidural spinal injections without relief. Serial MRI demonstrated moderate to high level suspicion for an infectious disease process concerning for L2-L3 discitis and adjacent osteomyelitis. The patient was admitted to a hospital for 5 days for work-up.

Setting: Tertiary Care Adult Hospital

Assessment/Results: Significant labs on initial presentation include WBC 6.44, Procal 0.16, ESR 51, CRP 6.3. Clinical, laboratory, and radiological findings were inconclusive for infectious etiology, so CT-guided diagnostic biopsy was performed in the lumbar region. Cultures demonstrated no growth after 5 days, and the patient was discharged from the hospital. The discitis was determined to be caused by a non-infectious inflammatory process, and the patient was diagnosed with psoriatic spondylodiscitis by diagnosis of exclusion. During outpatient follow-up at a pain management clinic, the patient was started on adalimumab 40 mg subcutaneous injections once every 2 weeks to control for psoriatic lesions and inflammation. Repeat MRI findings four months later showed decrease in overall inflammation, suggesting a positive response to the treatment.

Discussion (relevance): Spondylodiscitis is a complex disease whose diagnosis and management are challenging. Differentiating between infectious and non-infectious etiology is critical to avoiding delays in treatment or life-threatening infectious conditions.

Conclusions: Psoriatic spondylodiscitis should be considered in the differential when evaluating patients with a history of psoriasis and progressive low back pain. In patients with psoriatic spondylodiscitis, MRI findings can be suggestive of an infectious etiology but clinicians should correspond results with other objective findings.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-rare-case-of-psoriatic-spondylodiscitis-convoluted-by-unique-mri-findings-a-case-report/