MRI-negative Inflammatory Back Pain as an Unusual Manifestation of Takayasu Arteritis: A Case Report
Takayasu arteritis and spondyloarthritis are two rheumatological diseases whose co-existence is well-documented in the literature. Data on the presence of inflammatory back pain in Takayasu arteritis without a diagnosis of spondyloarthritis, however, is scarce. Here, we present a 33-year-old man who was admitted to the emergency department with acute-onset chest pain associated with left carotidynia, carotid bruit and left arm claudication, normal ECG, and CT angiographic features of Takayasu arteritis including stenosis and occlusion of the aorta and its branches. Two years prior, he had undergone a clinical work-up for an inflammatory back pain accompanied by alternating buttocks pain, morning stiffness lasting more than half an hour, and heel pain. His ESR was elevated (128 mm/1st hr) but he had negative serological tests (anti-dsDNA, anti-CCP, HLA-B27) and negative MRI of the sacroiliac joints. He was prescribed NSAIDs and placed on adalimumab 40 mg IM every two weeks since then but had to switch to etanercept, 2 months prior to his emergency admission due to supply issues. Oral prednisolone was initiated at a dose of 60mg/day with symptomatic improvement in both his inflammatory back pain and his chest pain but had to be switched to methotrexate and infliximab due to steroid side effects. Inflammatory aortitis should be considered as a possibility during the assessment of inflammatory back pain to mitigate the risks of delayed diagnosis.