Malnutrition in a patient with ankylosing spondylitis with special cause: Ankylosis of temporomandibular joints

Introduction.-Ankylosing spondylitis is a chronic inflammatory arthritis that predominantly affects axial structures. Although temporomandibular joints are commonly affected, the ankylosis is rare. Herein, we report the case of a patient suffering from undernutrition secondary to ankylosis of temporomandibular joints during ankylosing spondylitis. Observation.-The patient, 21 years old, had been followed since six years for juvenile idiopathic arthritis, identified three years ago as an ankylosina spondylitis. Since a year, the evolution had been marked by the occurrence of a limitation of mouth opening, impeding oral feeding, which became exclusively based on liquids. The patient was hospitalized in emergency for severe malnutrition with a weight loss of 15 kg in six months. The clinical exam showed a limitation of mouth opening, less than 10 mm, with impossibility of propulsive and lateral mandibular movements. Pelvic radiography showed a grade II sacroiliitis bilaterally and TDM a bilateral temporomandibular ankylosis. The patient had been previously treated with anti-inflammatory drugs and methotrexate, but the occurrence of diffuse cutaneous mycosis had required discontinuation of the latter. Osteolysis of the temporomandibular ankylosis was scheduled in the maxillofacial surgery service and treatment with biotherapy type infliximab considered after the fungal infection healing. Conclusion.-The early treatment of patients with ankylosing spondylitis should reduce the risk of progression to ankylosis of the temporomandibular joints and so the occurrence of such cases of malnutrition. (C) 2011 Elsevier Masson SAS. All rights reserved.