An unusual cause of chronic low back pain: ochronosis
Zeineb Alaya, Anis Mzabi
The Pan African Medical Journal. 2017;26:81. doi:10.11604/pamj.2017.26.81.11754

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An unusual cause of chronic low back pain: ochronosis

Cite this: The Pan African Medical Journal. 2017;26:81. doi:10.11604/pamj.2017.26.81.11754

Received: 24/01/2017 - Accepted: 31/01/2017 - Published: 21/02/2017

Key words: Ochronosis, calcification disc, low back pain

© Zeineb Alaya et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/26/81/full

Corresponding author: Zeineb Alaya, Department of Rheumatology, Farhat Hached Hospital, Faculty of medicine of Sousse, Ibn el Jazzar Street, 4000 Sousse, Tunisia (zeineb_a@hotmail.fr)


An unusual cause of chronic low back pain: ochronosis

Zeineb Alaya1,&, Anis Mzabi2

 

1Department of Rheumatology, Farhat Hached Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia, 2Department of Internal Medicine, Sahloul Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia

 

 

&Corresponding author
Zeineb Alaya, Department of Rheumatology, Farhat Hached Hospital, Faculty of medicine of Sousse, Ibn el Jazzar Street, 4000 Sousse, Tunisia

 

 

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A 45-year-old man presented with low back pain evolving since 8 years associated sometimes with a radicular radiation. The clinical examination found a patient in good general condition, a loss of the lumbar lordosis, an exaggeration of the dorsal kyphosis with stiffness of the lumbar spine. The cutaneous-mucosal examination showed a brownish appearance of the ears, conjunctiva, and lower eyelids. In biology there was neither inflammatory syndrome nor perturbation of the phosphocalcic balance. The standard radiographs of the lumbar spine (A) and dorsal spine (B) revealed multiple disc calcifications associated with large staggered disc clumps and discal empty images. Due to mucocutaneous signs, normality of biology and the radiological aspect, the diagnosis of ochronosis was suspected and confirmed by the test of blackening of the urine to the ambient air, the results of the cutaneous biopsy showed pigmented deposits yellow ocher and brownish in the dermis and the dosage of alkaptonuria. Symptomatic treatment resulted in moderate improvement. The family survey did not reveal any similar cases. Ochronosis or alkaptonuria is a rare autosomal recessive disorder of tyrosine metabolism. Deficiency of homogentisate 1,2 dioxygenase results in accumulation of oxidized homogentisic acid in the connective tissues of the skin, eyes and ears, musculoskeletal system, and cardiac valves, and in urolithiasis. Ochronosis is of late onset, responsible for the rachis of extended disc calcifications with maximum spinal fusion. It is the cause of degenerative arthropathy. Early diagnosis and screening of this disease are then of great interest, especially for genetic counseling.

 

 



Figure 1: the standard radiographs of the lumbar spine (A) and dorsal spine (B) revealed multiple disc calcifications associated with large staggered disc clumps and discal empty images

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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