A 12-year-old boy was referred to the hospital due to worsening low back pain and bilateral gluteal and upper thigh pain. Subsequently, he walked with an antalgic gait. The pain progressively increased in intensity for the subsequent three months. Upon questioning, he gave no history of altered bowel habits or urinary problems. In addition, he had no family history of a similar illness.
On examination, the patient was pink and afebrile. Tenderness was elicited at the lower back, glutei and bilateral upper thighs. The power of bilateral lower limbs was reduced to three-fifth, and the sensation was decreased from L1 to L3 dermatome levels. Laboratory data revealed mild hypochromic microcytic anaemia, average white cell count, creatine kinase, lactate dehydrogenase and C reactive protein. MRI showed no abnormality in the spine and brain. However, an abnormal hyperintense signal was noted on a limited view of both sacroiliac joints. Moreover, there was evidence of previous inflammation.
Finally, an MRI of the sacroiliac joints revealed asymmetric sacroiliitis and enthesitis of the hips and pelvis. Additional laboratory data showed negative rheumatoid factor and positive human leukocyte antigen (HLA) B27.
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