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Abstract
Several autoimmune and chronic inflammatory conditions have been consistently linked with an increased risk of hematologic malignancies. Although ankylosing spondylitis (AS) is a chronic inflammatory disease, previous studies have demonstrated that it is not associated with an increase in risk of malignant lymphomas. Cases of AS accompanied by hematologic malignancies such as multiple myeloma, chronic myelogenous leukemia, and Hodgkin's disease have been reported. In Korea, AS with non-Hodgkin's lymphoma or follicular lymphoma has not been reported. We experienced a 38-year-old male who had been diagnosed with follicular lymphoma with bone metastasis, who achieved complete remission after having been treated with chemotherapy, developed new inflammatory back pain. An MRI of his hip showed an active inflammation of the left sacroiliac joint and a positive HLA-B27. The patient was diagnosed with AS and was treated with naproxen, which improved the pain in his back and buttock.
References
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Figure 1.
(A) In 2007, this PET MIP image in 2007 taken at the diagnosis of lymphoma showed multiple hypermetabolic lymphadenopathy compatible with lymphoma and bone involvement at multiple sites of vertebrae (arrow) and pelvis. (B) A Bone bone scan showed shows moderately increased uptake at L4 compatible with compression fracture.
Figure 2.
Pathology of follicular lymphoma. (A) On H&E section, the enlarged follicles are arranged back to back (H&E, ×100) and on high power, follicular germinal center is replaced by centroblasts, without tin-gible body macrophages and pol-arity. The surrounding mantle zone is attenuated (B, H&E, ×200). On immunohistochemical stain, these cells were positive for CD20 (C) and Bcl-2 (D).
Figure 3.
Pelvis AP X-ray shows mild sclerotic changes and erosions along the bilateral SI joints (arrow).
Figure 4.
A Bone bone scan in 2011 at the diagnosis of ankylosing spondylitis shows mildly increased uptake at lower portion of the left SI joint region (arrow) and the left 1st metatarsal joint area (arrow).
Figure 5.
Magnetic resonance im-aging of hip shows irregular cortical erosion with subchondral cystic, sclerotic change along the SI joint, both and prominent inflammatory arthritis of the left SI joint (arrow). (A) PD fat suppression coronal scan (B) T1-weighted fat suppression with Gadolinium enhancement coronal scan.
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