An atypical presentation of axial spondyloarthritis with severe acute low back pain: A case report

Axial spondyloarthritis (axSpA) represents a chronic inflammatory condition primarily impacting axial joints, characterized by sacroiliitis and spondylitis. In axSpA patients, low back pain (LBP) typically assumes a chronic and inflammatory nature, where diagnostic delays can precipitate disability. However, atypical axSpA presentations pose challenges for early diagnosis and management. In the current study, we detail the case of a 39-year-old male presenting with acute, severe LBP and bilateral sacroiliitis. Initial treatment with non-steroidal anti-inflammatory drugs (NSAIDs), the standard first-line therapy, was discontinued due to severe gastrointestinal bleeding. Following a bone biopsy that excluded alternative etiologies, axSpA was confirmed based on diagnostic criteria. Elevated inflammatory markers, contraindications to NSAIDs, and magnetic resonance imaging findings prompted the initiation of anti-tumor necrosis factor (TNF) therapy. Remarkably, a marked improvement was observed in less than six weeks post anti-TNF therapy commencement. This case underscores the significance of recognizing atypical axSpA presentations and underscores the potential for swift and robust responses to anti-TNF agents. Optimal patient outcomes hinge upon effective disease pattern recognition and treatment selection.