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Zhenyuan Zhou, Hua Yue, Junyan Xu, Xiaoping Xu, Qiang Guo, Xiaoxiang Chen, Zhenlin Zhang, Chunde Bao, A case with tumour-induced osteomalacia misdiagnosed as axial spondyloarthritis, Rheumatology, Volume 57, Issue 12, December 2018, Pages 2242–2243, https://doi.org/10.1093/rheumatology/key255
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Sir, tumour-induced osteomalacia (TIO) is an exceptionally uncommon and intriguing paraneoplastic syndrome, clinically indistinguishable from axial spondyloarthritis (axSpA). Patients typically present with bone pain, difficulty in walking and restriction of spinal mobility. Differential diagnosis from axSpA is generally based on the absence of either positive HLA-B27 or radiographic evidence of sacroiliitis in TIO [1]. We hereby present a rare TIO case resembling asSpA with not only clinical presentation but also laboratory and radiographic features.
A 59-year-old male patient was admitted into our department with complaints of progressive low back pain for more than 10 years. At the beginning of his symptoms, the pain had been endurable and could be alleviated using oral analgesic or NSAIDs. Around 6 years ago, the symptoms developed insidiously, and he was subsequently referred to a rheumatologist. Laboratory tests in the clinic revealed positive HLA-B27, slightly elevated CRP and normal ESR levels. The CT scan at that time suggested level II sacroiliitis on both sides (Fig. 1A) and thus a diagnosis of axSpA was established. SSZ treatment was initiated together with NSAIDs when necessary. However, the pain was not relieved but rather worsened, and SSZ was replaced with other DMARDs including MTX, TNF inhibitors and traditional Chinese medicine. All these treatments failed and new symptoms developed, including spontaneous fracture and height loss, which brought the original diagnosis into question. Six months before admission, he was referred to a heamatologist. The FDG-PET/CT scan suggested diffused increase in FDG uptake in bone marrow. Nonetheless, the results showed normal in immunoprotein fixed electrophoresis and bone marrow biopsy. Therefore, he was referred to our department again for further evaluation. One month before admission, the patient noticed frequent urination.
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