Atraumatic thoracic spinal fracture mimicking herpes zoster neuralgia: a case report

J Med Case Reports, 2021 · DOI: https://doi.org/10.1186/s13256-021-02897-0 · Published: May 10, 2021

Rheumatology Research Methodology & Design Musculoskeletal Medicine

Simple Explanation

This case report discusses a patient with ankylosing spondylitis (AS) who experienced severe intercostal neuralgia, initially suspected to be herpes zoster, but was later found to have an atraumatic thoracic spinal fracture. The patient presented with intense intercostal pain, followed by numbness and weakness in both lower limbs and constipation. MRI revealed a thoracic vertebral fracture and spinal cord compression, necessitating emergency surgery. The case highlights that in patients with AS, severe intercostal neuralgia can be an early sign of spinal fractures, even in the absence of trauma. Spinal MRI is crucial for accurate diagnosis.

Study Duration

6-month postoperative follow-up

Participants

A 70-year-old Chinese Han man

Evidence Level

Level 4: Case Report

Key Findings

1
Severe intercostal neuralgia can be an early symptom of atraumatic spinal fractures in patients with ankylosing spondylitis.
2
Spinal MRI is crucial for diagnosing atraumatic spinal fractures, especially in patients with ankylosing spondylitis presenting with intercostal neuralgia.
3
Patients with ankylosing spondylitis are at a higher risk of developing spontaneous spinal fractures, even without a history of trauma.

Research Summary

This case report describes a 70-year-old man with ankylosing spondylitis who presented with severe intercostal neuralgia, initially misdiagnosed as herpes zoster. Further investigation revealed an atraumatic spinal fracture causing spinal cord compression. Emergency surgical intervention was performed, leading to improvement in the patient's symptoms, including pain relief and improved lower limb function. The case emphasizes the importance of considering spinal fracture in AS patients presenting with intercostal neuralgia. The authors conclude that severe intercostal neuralgia can be an early indicator of spinal fractures in AS patients, even in the absence of trauma, and that spinal MRI is essential for diagnosis and to prevent delayed treatment.

Practical Implications

Diagnostic Awareness

Clinicians should consider atraumatic spinal fractures in patients with ankylosing spondylitis presenting with intercostal neuralgia, even without a history of trauma.

Imaging Importance

Spinal MRI is essential for the diagnosis of atraumatic spinal fractures in ankylosing spondylitis patients with intercostal neuralgia.

Early Intervention

Prompt identification and intervention are crucial for improving the prognosis of patients with ankylosing spondylitis who develop spinal fractures.

Study Limitations

1
Limited generalizability due to being a single case report
2
Multicenter and large-sample clinical studies are required
3
Clinical characteristics of intercostal neuralgia and atraumatic spinal fractures in AS patients needs confirmation.

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