Case 37-1986: A 50-Year-Old Woman with Back Pain, Extensive Travel, and Exposure to Farm Animals

Presentation of Case A 50-year-old woman was admitted to the hospital because of an osteolytic lesion of the spine. She was well until six months earlier, when she experienced the abrupt onset of low-back pain that radiated down the left leg, accompanied by migratory arthralgia involving the ankles, wrists, elbows, shoulders, and right temporomandibular joint; the right elbow and left ankle became swollen. The joint pains subsided after two months, but back pain persisted, shifted to the low dorsal region, and was aggravated by walking. An extensive work-up performed elsewhere revealed that the urine was normal. The hematocrit was 37.