Double challenge: combination of ankylosing spondylitis and Madelung disease. Clinical case

Professional challenges face all doctors regardless of their specialty. Polymorbidity implies the presence of several diseases that have synchronous course in various phases and stages of their development, whether having common pathogenesis and genetic aspects or not. If polymorbidity is random, the impact of combined pathological conditions or diseases on the patient is potentially negative. Each case requires analysis, particularly, a combination of some rare diseases due to the lack of relevant information in medical scientific literature. This article deals with a case of ankylosing spondylitis (AS) combined with multiple diffuse lipomatosis of the neck (Madelung disease). Although AS is a well‑ known condition, Madelung disease still remains a rare and insufficiently studied pathology. The article presents a clinical case of patient О., a 59‑year‑old male, admitted to the rheumatology department of Khmelnytskyi Regional Hospital, who had been ill for more than 20 years, had never been comprehensively examined being treated sporadically. After the patient had undergone comprehensive examination using physical, clinical, laboratory and instrumental methods, the diagnosis was made, the course of combination therapy and a number of rehabilitation measures were administered, and proper medical recommendations were given to him at discharge. The major trigger pattern both in AS and Madelung disease is damage to the neck. In AS, the bone structures are affected, and in Madelung disease — the adipose tissue. Thus, one anatomical region — the neck — is exposed to «double blow», and the clinicians — to «double challenge», as combination of those two pathologies in one anatomical region makes a danger of its progression. The purpose of the paper is to evaluate the specifics of mutual influence, determine the features of diagnosis in polymorbidity of AS and Madelung disease, demonstrate the synergy of negative effects of both pathologies on the quality and prognosis of the patient’s life, analyse the likelihood of a pathogenetic link between the diseases, and optimise treatment and rehabilitation.