IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Enteropathic axial spondyloarthritis

Case contributed by Francis Deng
Diagnosis almost certain

Presentation

Acute on chronic back pain, abdominal pain, and non-bloody diarrhea. History of colonic Crohn disease, on infliximab.

Patient Data

Age: 18 years
Gender: Male

MR enterography

mri
  • colonic wall thickening, edema, restricted diffusion, and surrounding inflammatory changes, extending from the coecum to mid-transverse colon and to a lesser extent the remainder of the colon but sparing the rectum
  • reactive ileocolic lymph nodes
  • trace ascites
  • contrast enhancement and diffusion restriction at the left anterior aspect of the superior endplate of the L2 vertebra and adjacent soft tissue

MRI lumbar spine

mri
  • bone marrow edema-like signal and cortical irregularity at the left anterosuperior margin of the L2 vertebra
  • fatty marrow change at the anteroinferior corner of L1 and anterosuperior corner of L2 vertebral bodies
  • Vertically oriented, left eccentric new bone formation at the anterosuperior corner of L2 vertebral body with thick implantation base
  • bilateral mild subchondral marrow edema-like signal at the sacroiliac joints
  • mild disc degenerative changes at T10-11 through L1-2, including disc height and signal loss and Schmorl node formation at the posterior part of the endplates

Case Discussion

The MR enterography demonstrated pancolitis, in keeping with an active flare of the patient's known Crohn colitis. The lumbosacral spinal MRI shows evidence of bilateral sacroiliitis as well as findings at the anterior corner of the L2 vertebral body compatible with a Romanus lesion and pseudosyndesmophyte. Further history taking indicated that the back pain waxed and waned in line with monthly biologic therapy (infliximab) administration, supporting the inflammatory etiology of the symptom. In the setting of inflammatory bowel disease, the findings support a diagnosis of enteropathic axial spondyloarthritis.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.