Ankylosing spondylitis (Marie Strumpell's disease) is a chronic inflammatory disease which principally affects the axial skeleton. The earliest radiographic sign in 90% of the patients with ankylosing spondylitis is a bilateral sacroiliitis. Up to 3% of the patients with ankylosing spondylitis will not present with the initial sacroiliitis. A case is reported of a patient with an atypical presentation. The patient's radiographic presentation consisted of syndesmophytosis without sacroiliac involvement. However, due to the patient's symptoms, radiographic appearance, and laboratory studies, the diagnosis of an atypical ankylosing spondylitis was chosen.
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