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23rd April 2024
A 53-year-old female with PBC presents with back pain. She noticed it a few weeks ago
A 53-year-old female with PBC presents with back pain. She noticed it a few weeks ago when she got out of bed in the morning. She has had the pain for a number of weeks now and it is affecting her mobility. She had a urinary infection a few weeks ago, which was treated with oral antibiotics in the community and has otherwise been well in herself. She takes ursodeoxycholic acid for PBC. She was told at her last clinic appointment things are relatively well controlled at present. On examination, she is very tender on palpation of T11. There is no obvious leg weakness and no paraesthesia of the lower limbs. There are no stigmata of chronic liver disease.
Investigations show the following:
| Haemoglobin | 115 g/L |
| White Cell Count | 4.8×10⁹/l |
| Platelets | 370 10⁹/l |
| Bilirubin | 19 μmmol/ |
| Alkaline Phosphatase | 190 μmmol/ |
| ALT | 30 iu/l |
| AST | 25 iu/l |
| Calcium (adjusted) | 2.1 mmol/l (2.2-2.6) |
| Phosphate | 0.4 mmol/L (range 0.7-1) |
| CRP | 15 |
| Albumin | 35 g/l |
What is the most likely diagnosis?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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