A 47-year- old man presented
in August,2004 with ,a three years
duration , of insidious Low back pain
and stiffness.
His back stiffness was more severe and
pronounced at waking-up in the
morning , the pain and stiffness eased
with activity as the day is going on.
The pain was dull in nature , radiated
to his buttocks , and poorly localized.
He had no recent illnesses . His past
medical history included a lithotomy
from Urinary bladder , 5 years ago.
Also he noticed progressive darkening
of the skin over his face for the last
several years.
On the examination , the patient
had dark discolorations of the face
mainly over checks, nose and
triangular dark pigmentation of both
sclera.
The normal cervical and lumbar
lordosis were obliterated , with
restriction of movement of the entire
spine in all planes , while chest
expansion was preserved , No local
spinal or paraspinal tenderness , no
evidence of enthesitis else where in the
body. No neurological deficit could be
detected.
Routine blood investigation ( complete
blood picture) was within normal
range. General urine examination
revealed protienuria , pyuria. On
keeping the urine in test tube , the
color progressively darken , few hours
later.
Plain chest x .ray showed no
abnormal findings , Echo examination
revealed no cardiac or valvular lesions.
Conventional plain x . ray of spine
revealed , sever osteoarthritic changes ,
with severe narrowing of disks , with
normal sacro iliac joints.Plain x . ray
and ultrasound study revealed
presence of stag horn stone in left
kidney .