Sacral osteoid osteoma: a rare cause of inflammatory back pain and sacroiliitis in a young man

• Published in: BMJ case reports 2021-08, Vol.14 (8), p.e244074
• Main Authors: Chandwar, Kunal, Lathiya, Harsh, Gohel, Abhishek, Shah, Chandani
• Format: Article
• Language: English
• Subjects: Ablation; Back pain; Back Pain - etiology; Bone diseases; Bone marrow; Bone Neoplasms - complications; Bone Neoplasms - diagnostic imaging; Calcification; Case reports; Edema; Humans; Images In; Male; Mens health; Osteoma, Osteoid - diagnosis; Osteoma, Osteoid - diagnostic imaging; Pediatrics; Sacroiliitis; Sacroiliitis - diagnostic imaging; Sacrum - diagnostic imaging; Tumors; Young adults
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-244074

A 29-year-old man with a 10-year history of low back pain presented with increasing frequency and intensity of inflammatory back pain for the last 1 month with early morning stiffness of about 30 min, pain maximum at night, often disturbing sleep and excellent response to NSAID (Non Steroidal Anti-Inflammatory drugs). On examination, the Patrick’s/flexion, abduction and external rotation test and pelvic compression test were suggestive of right sacroiliac involvement, but there was no spinal movement restriction and chest expansion was normal. The inflammatory markers and blood counts were within limits and an HLA-B27 was negative. The patient, a neurology fellow, was advised a radiograph of sacroiliac joints but preferred an MRI over it. MRI performed showed low signal intensity nidus with surrounding bone marrow oedema in the anterior juxta-articular region of the right sacral ala. The articular margins were normal without any erosive changes that ruled out acute or chronic arthritis (figure 1). Further, CT was done that revealed radiolucent nidus with central calcification and surrounding reactive sclerosis in the anterior aspect of right sacral ala (figure 2), which confirmed the lesion to be an osteoid osteoma.