© 2002 by Annals of the Rheumatic Diseases
LESSON OF THE MONTH
Painted black
Series editor: Anthony D Woolf
1 Department of Orthopaedic Surgery, University Hospital Groningen, PO Box 30.001, RB Groningen, The Netherlands
2 Department of Orthopaedic Surgery, Deventer Hospital, PO Box 5001, GC Deventer, The Netherlands
Correspondence to:
Correspondence to:
Dr Maathuis;
p.maathuis@orth.azg.nl
Accepted 13 Jul 2001
Keywords: alkaptonuria; enzyme deficiency
A 65 year old patient attended our hospital because of painful degenerative arthritis of the left hip joint. Chronic low back pain was a concomitant complaint. For this she had been treated elsewhere under the diagnosis ankylosing spondylitis. Coincidentally, she mentioned that she had had unpleasant dark stains in her underwear since childhood, which became more intense after washing. Her two sisters and the youngest daughter of one of them had the same complaints. General inspection showed black pigmentation in both sclera (fig 1
). The radiographs of the lumbar spine showed degeneration of the discs with narrowing of the space and dense calcification of the remaining disc material. The radiological appearance resembled a "bamboo spine" (fig 2). Routine laboratory investigations showed no abnormalities.
[in a new window] Figure 1 Black pigmentation in sclera of the patient.
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[in a new window]
Figure 2 Radiograph of the lumbar spine of the patient. Notice the bamboo spine appearance without osteophytes and calcification of | |||||||||
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