Issue: 2018 > October > photo quiz

Back and joint pain according to good old Virchow

K. van Stapele, E.C.T. Geijteman, T.C. van Thiel, P.T.E. Postema, D.H. Schweitzer
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A 58-year-old Iraqi male presented to our internal medicine outpatient clinic with long-term complaints of pain in the lower back, accompanied by stiffness and arthralgia. In an attempt to alleviate his symptoms, he underwent a neurosurgical intervention some years earlier, in which a spinal schwannoma was removed. However, this intervention did not relieve his symptoms. Family history unveiled that two of his eight siblings cope with similar issues. The patient had a history of diabetes mellitus, obesity and bladder stones. Physical examination revealed a wheelchair bound man, with pigmentation abnormalities of facial skin, auricles, sclerae and hands (figure 1). He had arthralgia of all of his large and small joints, as well as lumbago upon movement, but no signs of acute inflammation or radicular pain. Screening blood tests were normal, with regular levels of vitamin D, calcium, phosphate, normal renal function and no indications of autoimmune antibodies or inflammatory response. X-ray imaging of the lumbar spine, prior to neurosurgical intervention, showed multilevel narrowing of the disc spaces, disc calcifications and anterior osteophytes (figure 2).

W H A T I S Y O U R D I A G N O S I S ?

See page 384 for the answer to this photo quiz.