1/525. Subacute measles encephalitis in a young man immunosuppressed for ankylosing spondylitis. Subacute measles encephalitis occurred 1 month after measles onset in a 26-year-old hiv-negative man undergoing immunosuppressive treatment for ankylosing spondylitis. He had seizures, a decline in mental status, and progressive impairment of consciousness, with a fatal outcome. Despite severely deficient cellular immunity, the elevated antimeasles antibody titers and CSF findings indicated that humoral immunity was not impaired. Histologic, electron microscopic, and immunocytochemical studies revealed the typical intranuclear inclusions of paramyxovirus nucleocapsids, and measles virus antigen in neurons and oligodendrocytes. ( info) |
| Six patients with ankylosing spondylitis and features of a cauda equina syndrome are described. The myelographic findings are discussed in relation to the pathogenesis of the disorder and its natural history. Present experience suggests that the cauda equina syndrome is a more common complication of ankylosing spondylitis than is usually thought. ( info) |
3/525. Effectiveness of lymphocytapheresis in a patient with ankylosing spondylitis. immunomodulation by lymphocytapheresis (LCA) was carried out in a patient with ankylosing spondylitis (AS) who suffered severe pain in joints and back. LCA was performed once a week and 3 x 10 9 lymphocytes were extracted each time. Fifteen courses of LCA were completed. The joint score was gradually decreased and the improvement was maintained 11 months after treatment. The population of NK cells detected by Leu-7 and Leu-11 monoclonal antibodies decreased and HLA-DR positive CD3 cells increased during and after the treatment. The effectiveness of LCA in AS may confirm the participation of immunological mechanisms in the pathogenesis of AS. ( info) |
| Ankylosing spondylitis can be associated with extra-articular involvement. Besides internal and ocular complications, neurological manifestations such as single root lesions, compression of the myelum or the cauda equina syndrome have also been described. We present a patient with ankylosing spondylitis who developed a monophasic myelopathy resembling multiple sclerosis. literature data show no conclusive evidence for an increased association of ankylosing spondylitis and multiple sclerosis. However, a monophasic myelopathy may be a separate neurological manifestation associated with ankylosing spondylitis. ( info) |
5/525. Surgically induced necrotizing scleritis in a patient with ankylosing spondylitis. We present the case of a 75-year-old man with ankylosing spondylitis who developed surgically induced necrotizing scleritis (SINS) more than 3 years after uneventful extracapsular cataract extraction and posterior chamber intraocular lens implantation. The patient presented with a painful eye and increasing vertical diplopia. To our knowledge, neither the association of SINS and ankylosing spondylitis nor vertical diplopia as its presenting complaint has been described. ( info) |
6/525. "Ankylosing spondylitis" without sacroiliitis in a woman without the HLA B27 antigen. An elderly woman with otherwise typical ankylosing spondylitis for 45 years lacked radiologic evidence of sacroiliitis and the HLA B27 antigen. The illness was complicated by renal tuberculosis requiring a left nephrectomy 23 years after the onset of low back pain, and 20 years after an episode of severe iritis. After the eradication of the tuberculosis by surgery and chemotherapy, she has continued to have symptomatic spondylitis. The case seems to be an exception to the rule that sacroiliitis is a sine qua non for ankylosing spondylitis. women with ankylosing spondylitis tend to have milder disease with an apparently lower frequency of roentgenographic changes in sacroiliac joints. ( info) |
7/525. Do pathological opposites cancel each other out? Do all patients with both hypermobility and spondylarthropathy fulfill a criterion of any disease? When a patient with hypermobility syndrome suffers from ankylosing spondylitis or seronegative spondylarthropathy with spinal stiffness, a part of the mobility criterion of the one disease may be "eliminated" due to the other illness. These two cases may represent typically such opposite effects on mobility. ( info) |
8/525. bacillus Calmette-Guerin associated arthropathy mimicking undifferentiated spondyloarthropathy. The development of an inflammatory arthritis mimicking an undifferentiated spondyloarthropathy (SpA) was seen in a patient being treated for a superficial bladder cancer with intravesical bacillus Calmette-Guerin (BCG). Physical findings included classic dactylitis of both feet. This is the fourth report identifying a patient with BCG induced articular findings suggestive of a SpA with dactylitis. Studies of BCG stimulated cytokine secretion from peripheral blood mononuclear cells showed the patient to have enhanced interleukin 6 (IL-6) levels and reduced interferon-gamma (IFN-gamma) levels. Spontaneous IL-6 secretion was markedly elevated for the patient, compared to the control subject, but IFN-gamma secretion was quite similar. No differences were apparent with IL-4. ( info) |
9/525. Double spinal cord injury in a patient with ankylosing spondylitis. Ankylosing spondylitis patients are more prone to spinal fractures and these fractures commonly result in mobile nonunion. We report a patient with a 30-year history of ankylosing spondylitis who sustained double spinal cord injuries following minor trauma. The first injury occurred at the lumbar level due to pseudoarthrosis of an old fracture, and the second at the thoracic level following cardiopulmonary arrest and an episode of hypotension. The possible mechanisms of the injuries are discussed and maintaining normal blood pressure in these patients is emphasized. ( info) |
10/525. Cystic rheumatoid arthritis with Felty's syndrome and ankylosing spondylitis. A 63-year-old man with strictly axial ankylosing spondylitis since the age of 28 years had a seven-year history of cystic seronegative rheumatoid arthritis with Felty's syndrome. cysts were present in the hands, feet, wrists, shoulders, hips, one elbow, and one knee. There was no evidence of juxtaarticular demineralization, joint space loss, erosions, or joint destruction. Rheumatoid pannus was demonstrated within the cysts, particularly at the hip, ruling out cystic hip disease due to ankylosing spondylitis. HLA typing demonstrated the B27 and DR4 haplotypes. HLA B27 may be associated with a worse prognosis of rheumatoid hip involvement. ( info) |