Novel markers in predicting Brucella sacroiliitis:The platelet large cell ratio and basal immature reticulocyte fraction

Objective:To present platelet large cell ratio(P-LCR),reticulocyte,and immature reticulocyte fraction(IRF)values as novel parameters in diagnosis and response to treatment in patients developing sacroiliitis.Methods:Sixty-eight patients with clinical symptoms and Brucella standard tube agglutination(Wright)or Brucella Coombs agglutination test titers≥1:160 were included in the study.Two groups were established,one developing sacroiliitis and another with no sacroiliitis development.P-LCR,reticulocyte,and IRF levels were measured using a Sysmex XN-9000 device(Japan).These were then compared between the two groups.Results:Reticulocyte(P=0.037)and IRF(P=0.026)levels were significantly lower among the patients developing sacroiliitis compared to the non-sacroiliitis group,while P-LCR(P=0.003)levels were significantly higher.P-LCR had the most powerful correlation with sacroiliitis development.Significant negative correlation was observed between reticulocyte,IRF levels and sacroiliitis.Conclusions:Elevated P-LCR levels were observed as a marker of persisting inflammation in patients developing sacroiliitis,while low reticulocyte and IRF levels secondary to bone marrow involvement were detected.These three parameters emerged as highly significant markers in terms of diagnosis and reflecting responses to treatment in organ involvement such as sacroiliitis in brucellosis.These are presented as inexpensive,and easily accessible novel parameters.

Tuberculous Sacroiliitis with Secondary Psoas Abscess: A Case Report

Tuberculous sacroiliitis secondary to a psoas abscess is rare, only a few sporadic cases were reported in the literature. Tuberculous sacroiliitis is rare, usually unilateral, its symptomatology is misleading, its diagnosis is often delayed or even confused with damage to the hip or lumbosacral hinge, most often related to difficulties exploration of the sacroiliac joint. We report the case of a 66-year-old diabetic patient with low back pain, unilateral right with inflammatory appearance, insidious installation, evolving for about 8 months. The diagnosis of tuberculous sacroiliitis was made after biopsy of the sacroiliac joint. CT and MRI are necessary for lesion diagnosis. Tuberculosis treatment was started and the abscess was surgically drained. The aim of this work was to describe the diagnostic pathway of a patient with tuberculous sacroiliitis in a tropical environment. Conclusion: Tuberculous sacroiliitis, secondary to an abscess of the psoas muscle is an unusual cause of hip pain and is likely to be overlooked due to its atypical presentation.

Concurrent ankylosing spondylitis and myelodysplastic syndrome:A case report

BACKGROUND Ankylosing spondylitis(AS)is an autoimmune disease characterized by sacroiliitis and spondylitis,with a few hematological abnormalities.Myelodysplastic syndromes(MDS)are a heterogeneous group of hematopoietic stem cell disorders with frequent autoimmune phenomena.The relationship between AS and MDS remains unknown.CASE SUMMARY We describe a rare case of concurrent AS and MDS.An 18-year-old man with low back pain and anemia was diagnosed with AS;however,the cause of anemia could not be determined by the first bone marrow examination.He recovered from anemia and the symptoms of AS resolved after treatment with etanercept,glucocorticoid,and blood transfusion,but he developed pancytopenia with an increased myeloblast count(from 2.5%to 9%).Chromosome analysis revealed del(7q)and trisomy 8.Refractory anemia with excess of blasts-1(RAEB-1)/MDS was confirmed by repeating the bone marrow examination.He became blood transfusion-dependent and received decitabine-based chemotherapy but eventually died.CONCLUSION We suspect that AS may be an early autoimmune phenomenon related to MDS.However,a condition of coexistence cannot be excluded.

Occurrence of human leukocyte antigen B51-related ankylosing spondylitis in a family:Two case reports

BACKGROUND Ankylosing spondylitis(AS)is strongly associated with the human leukocyte antigen(HLA)B27 haplotype.In regions where conventional polymerase chain reaction for HLA typing is available for antigens such as HLA B27 or HLA B51,it is common to perform the HLA B27 test for evaluation of AS.While HLA B27-associated clustered occurrences of AS have been reported in families,we report the first case series of HLA B51-related occurrences of AS in a family.CASE SUMMARY A father and his daughters were diagnosed with AS and did not have the HLA B27 haplotype.Although they were positive for HLA B51,they exhibited no signs of Behçet’s disease(BD).Of the five daughters,one had AS,and three,including the daughter with AS,were positive for HLA B51.The two daughters with the HLA B51 haplotype(excluding the daughter with AS)exhibited bilateral grade 1 sacroiliitis,whereas the daughters without the HLA B51 haplotype did not have sacroiliitis.Thus,this Korean family exhibited a strong association with the HLA B51 haplotype and clinical sacroiliitis,irrespective of the symptoms of BD.CONCLUSION It is advisable to check for HLA B51 positivity in patients with AS/spondyloarthropathy who test negative for HLA B27.