Non-Radiographic Axial Spondyloarthritis Presenting with Anterior Chest Wall Pain without Inflammatory Back Pain in an HLA-B27-Negative Young Man: A Case Report Highlighting Diagnostic Challenges.
Roddy Gergeus, Ahmad Bishr Nasra, Rawia Barghouth et al.
✦ AI-curated · Sources linked
Case in brief
A 22-year-old HLA-B27-negative male presented with mild anterior chest wall pain, initially deemed mechanical and treated with NSAIDs. Eight months later, he experienced severe right hip pain and recurrent chest pain, with elevated inflammatory markers but no inflammatory back pain. MRI revealed unilateral active sacroiliitis, leading to a diagnosis of non-radiographic axial spondyloarthritis. Treatment with NSAIDs and DMARDs provided partial relief, but rapid improvement followed initiation of golimumab.
What made this case unusual
The case highlights the presentation of non-radiographic axial spondyloarthritis without inflammatory back pain in an HLA-B27-negative patient, complicating diagnosis.
Diagnostic / clinical pearl
MRI is crucial in diagnosing non-radiographic axial spondyloarthritis when conventional imaging fails to show definitive changes, especially in atypical presentations.
Why it matters
Recognizing non-radiographic axial spondyloarthritis in patients without classic symptoms can prevent delays in diagnosis and treatment, improving patient outcomes.