AN ATYPICAL PSORIATIC SPONDYLITIS CASE, SUCCESSFULLY TREATED WITH METHOTREXATE

We present a 45 - year-old male patient who was hospitalized with lumb ar disc herniation and whose control magnetic resonance imaging (MRI) findings initially suggested brucella spondylitis. Definitive diagnosi s, however, indicated psoriatic spondylitis and the patient was succes fully treated with methotrexate. A diagnosis of lumbar disc herniation was made in May 1991, during his psoriasis vulgaris treatment. He was hospitalized in August 1994 with a complaint of low-back pain persist ing over the last six months despite treatment with analgesics. He was evaluated by clinical, radiological, laboratory and scintigraphic met hods, following control MRI findings suggesting infection of vertebral bodies, particularly pointing to brucellosis in addition to disc hern iation. A diagnosis of psoriatic spondylitis was finally established a nd 7.5 mg methotrexate weekly was administered. Significant improvemen t was obtained of psoriatic skin lesions, low-back pain and MRI findin gs through a six-month treatment period.