A 16-year-old woman presented with complaints of severe pain in the sternum, between the shoulder blades and deep in the lower back for 3 months, especially in the morning and at rest.
Examination findings
Pressure pain could be triggered at the sternum and in the middle thoracic spine area. The spine mobility was reduced. A psoriatic-like squamous skin lesion was found on the right lower leg. The BSG was increased to 20/44 mm. There was a minor iron deficiency anemia. The other laboratory findings were within the normal range. HLA-B27, RF, ANA, ENA, dsDNA-AK, p/s-ANCA and ACE were negative.
Radiological findings
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Normal appearance of the thoracic and lumbar spine on X-ray, while CT shows an erosion defect at the impressed ground plate of T4.
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In MRI, T2-weighted hyperintense lesions are found at BWK 4 and 11 as well as LWK 1 and 5, with contrast-enhancing foci at the ventral vertebral body edges, surrounded by bone marrow edema (“shiny corners”). BWK 4 shows a disc impression.
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There is a band-shaped osteolysis with marginal sclerosis on the sternal body.
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Both sacroiliac joints are unremarkable.
Which diagnosis is the most likely?
