Case Presentation
A 45-year-old male with no prior medical history was diagnosed with AS
about ten years ago following bilateral Achilles tendonitis, rupture of
the left Achilles tendon, inflammatory low back pain, positive HLA B27,
and increased inflammatory markers. Sacroiliac X-ray showed bilateral
Sacroiliitis (Figure 1), then he was managed with Sulfasalazine and
NSAID at anti-inflammatory. About one year ago, the case felt tingling
and numbness, firstly in the upper limbs and then in the lower limbs.
Upon consultation with a rheumatologist, he underwent tests such as
EMG-NCV, vitamin B12, and folate levels. EMG-NCV result showed
axonal-type sensory-motor polyneuropathy and laboratory tests
demonstrated a normal range of vitamin B12 and folate levels. Laboratory
tests showed in Table 1.
Considering the inconsistency between the patient’s neuropathy and AS,
additional examinations were performed, including CT scans of the lungs,
abdomen, and pelvis and tumor marker tests to investigate the
possibility of malignancy. The tumor markers range is shown in Table 1.
All requested tests demonstrated normal results, and the criteria for
demyelinating neuropathy were absent in the EMG-NCV; this neuropathy
subtype was not considered a potential etiology. Eventually, based on
the findings, no justification for the patient’s neuropathy was
identified, and the absence of any secondary cause was proposed as the
etiology; hence, AS considers an etiology of Axonal Sensory-Motor
Polyneuropathy, a rare presentation for this disease.