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The case of a 52-year-old man with retroperitoneal fibrosis and ankylosing spondylitis is described. Inflammatory low back pain and acute renal insufficiency prompted a computed tomography scan of the abdomen with contrast agent injection. A fibrous sheath surrounding the aorta and attracting the ureters toward the midline was seen, strongly suggesting retroperitoneal fibrosis. The diagnosis of ankylosing spondylitis was based on the presence of inflammatory low back pain responsive to nonsteroidal anti-inflammatory drugs, syndesmophytes at the lumbar and cervical spine, bilateral sacroiliitis, and presence of the HLA-B27 antigen. Prednisone therapy in a daily dosage of 1 mg/kg induced a marked improvement. Only nine cases of concomitant retroperitoneal fibrosis and ankylosing spondylitis have been reported. These two conditions share similarities in some of the etiologic factors and anatomic localizations, suggesting that both may stem from a predisposition to fibrotic diseases.

Idiopathic chondrolysis of the hip is a rare disease in which gradual necrosis of the hyaline cartilage covering the femoral head and acetabulum leads to joint space narrowing and motion restriction. Pain, motion range limitation, and radiographic joint space narrowing are the main manifestations. We report 2 cases in 15-year-old girls, one black and the other Caucasian. Unexplained pain and motion restriction in the left hip were the presenting manifestations. Narrowing of the hip joint space was noted on standard radiographs. Magnetic resonance imaging showed a joint effusion in 1 patient and unevenness of the femoral head contour in the other. Laboratory tests including microbiological studies were normal or negative. Nonspecific synovitis was found in biopsy specimens. Immobilization and traction were the main components of the treatment strategy.

Pleuropulmonary involvement was long described as an uncommon and late event in the course of ankylosing spondylitis (AS). This belief was based on studies that relied on symptoms and chest radiographs to evaluate the lungs. However, pleuropulmonary involvement in AS patients is usually asymptomatic, and the early lesions are undetectable on chest radiographs. Apical fibrosis, interstitial infiltrates, and pleural thickening were considered to be the main patterns. However, the introduction of high-resolution computed tomography (HRCT) has led to the description of many pulmonary abnormalities that are clinically silent and undetectable on plain radiographs. These abnormalities mainly affect the interstitium and have no influence on respiratory function, which is dependent on the severity of chest wall inflammation or ankylosis in recent-onset and established AS, respectively. Cytological and histological studies suggest that, in common with uveitis and aortic regurgitation, the structural lung changes shown by HRCT may be specific of AS.

Ankylosing spondylitis is a chronic inflammatory joint disease in which inflammation of the entheses gradually causes local ossification and ankylosis. Diffuse osteoporosis responsible for bone fragility is another feature established by recent data. The bone loss predominates at the spine and can cause vertebral fractures that are rare but nonnegligible sources of mortality and morbidity late in the course of the disease.