Author(s): Aditya Gupta1, Rajesh Kumar Gupta2

PRESENTATION OF THE CASE A 40-year-old patient presented to us with chief complaints of low back pain & large joint polyarthralgia for the last 8 years. Pain was more on bending forward, prolonged standing/sitting. There was also morning stiffness in the back. Pain was mild to moderate in intensity. There was no radiation of pain. Pain used to get relieved with rest & with NSAIDs. Patient also complained of black discolouration of urine when he urinated in the open. There was no other complaint. On examination he had bluish discolouration of pinna of right ear (Figure 1). On ocular examination, bluish black discolouration was noted between the corneal margin and the inner canthus. Right knee was held in 15 degree of flexion. There was also retrocalcaneal swelling & tenderness. Lumbar lordosis was obliterated and tenderness was present at dorsolumbar spine with paravertebral spasm. SLR was 80 degrees on both sides. No neuro-deficit was present. X-ray Dorsolumbar spine showed calcification of intervertebral disc with degeneration present at multiple levels (Figure 2). X-ray knee showed reduced joint space which was uniform in both knees. There was diffuse osteoporosis but osteophytes were relatively absent. There was extensive subchondral sclerosis and intraarticular loose bodies were also present.