Not just another case of low back pain

A 55-year-old woman presented with persistent, progressive low back and neck pain for 5 years that had failed conservative therapy with analgesics and epidural injections. Physical examination revealed range of motion of lumbar and cervical spine were significantly limited in all directions and she had a bluish discolouration of the pinnae bilaterally. She had elevated urinary excretion of homogentisic acid, diagnostic of alkaptonuria. Further investigation with imaging of the spine revealed diffuse advanced degenerative disease of the cervical and lumbar spine consistent with ochronotic arthropathy.