Question

a 15 - year - old male presents with nocturnal pain in the low back, fatigue, and malaise. nothing seems to make the pain better. physical examination revelas a left lateral convexity of the lumbar spine. what is your diagnosis?
a) osteoid osteoma
b) osteoarthritis
c) rheumatoid arthritis
d) scoliosis
e) ankylosing spondylitis

Explanation:

• Osteoid Osteoma: Common in children and adolescents. Presents with nocturnal pain that is often relieved by non - steroidal anti - inflammatory drugs (NSAIDs), but in some cases, nothing seems to make the pain better. Can cause a lateral convexity (scoliosis - like deformity) of the spine due to muscle spasm to relieve pain.
• Osteoarthritis: Usually affects older adults (wear - and - tear arthritis). Not typical in a 15 - year - old.
• Rheumatoid Arthritis: Systemic autoimmune disease. Usually affects small joints symmetrically (hands, feet) first, not typically presenting with isolated lumbar spine convexity and nocturnal low back pain as the main features in a 15 - year - old.
• Scoliosis: A lateral curvature of the spine. While it can cause a lateral convexity, it is usually not associated with nocturnal pain, fatigue, and malaise as the primary symptoms (unless there is an underlying pathological cause like in osteoid osteoma - induced scoliosis).
• Ankylosing Spondylitis: Usually presents with morning stiffness, pain improving with activity. Onset is often in late adolescence/early adulthood, but the classic symptom is inflammatory back pain (improving with movement, worse in the morning) rather than nocturnal pain that is not relieved by anything and a single lateral convexity.

Answer:

A. Osteoid Osteoma