Spondylodiscitis as the only clinical manifestation of the onset of psoriatic spondyloarthritis.

We report the case of a 47-year-old man with insidious onset of progressively disabling back pain in the dorsal region. The patient had minimal dermatitic lesions to the elbows and behind the ears, which were attributed to minimal psoriasis. An initial MRI of the spine, one month after the onset of symptoms, showed an alteration in the D7-D8 vertebrae as from bone marrow edema. The successive CT scan of the spine, after about six months, showed a significant osteolytic process of the D7 and D8 vertebrae and extensive swelling of surrounding tissues. A contemporary lung CT scan showed opacity in the right lung. A first hypothesis of lung cancer with vertebral metastases was ruled out by the negative bronchoscopy and the subsequent disappearance of lung opacity after antibiotic therapy. A CT-guided needle biopsy of the spine gave negative results for granulomatous and infectious tumor pathology. The later appearance of peripheral polyarthritis and the presence of initial bone marrow edema justified the diagnosis of psoriatic spondylodiscitis. Therapy with anti-TNF-alpha (Eternacept) was initiated, with which both the painful symptomatology and the radiological damage were quickly resolved. This is the first case in literature about spondylodiscitis as the manifestation of the onset of psoriatic spondyloarthritis.