547 - Rare Presentation of Human Papillomavirus-Associated Squamous Cell Carcinoma: A Case of Radiculopathy Involving the Iliopsoas Muscle, Sacrum, Ilium, and L4-L5 Spinal Regions

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

CR

Colton W. Reeh, MD

Resident Physician
Baylor College of Medicine
houston, Texas, United States
TL

Ton La, Jr., MD, JD

Resident Physician
Baylor College of Medicine
Houston, Texas, United States

Co-Author(s)

JP

Jason Parmar, DO

Resident Physician
Baylor College of Medicine
Houston, Texas, United States
FM

Felix K. Mintah, MD

Resident Physician
Baylor College of Medicine
Houston, Texas, United States
DB

Donna M. Bloodworth, MD

Resident Physician
Baylor College of Medicine
Houston, Texas, United States

Case Diagnosis: Right L4-L5 radiculopathy secondary to human papillomavirus (HPV) associated squamous cell carcinoma (SCC) involving the iliopsoas muscle, sacrum, ilium, and L4-L5 osseous regions of the spine with lymphadenopathy.

Case Description: A 48-year-old female presents to an outpatient clinic with right hip pain and allodynia with radiation down the lateral portion of the thigh to the foot of duration two years in addition to thigh and hip weakness, resulting in the loss of ability to ambulate three days before presentation. Physical examination was significant for generalized tenderness overlying the right lumbar spine, weakness with right hip flexion and knee extension, and sensory changes along the L4-L5 dermatome. Labs obtained were significant for microcytic anemia (hemoglobin 9.5, MCV 67.8), thrombocytosis (platelets 608), elevated total protein (8.5), and elevated alkaline phosphatase (196). In the setting of loss of ambulation and abnormal laboratory values, the patient was sent to the emergency department (ED) for magnetic resonance imaging (MRI) which revealed an infiltrative mass involving the iliopsoas muscle, sacrum, ilium, and right L4-L5 pedicles and transverse processes with biopsy positive HPV-associated non-keratinizing SCC.

Discussions: Prior to presentation, the patient had multiple ED and primary care provider visits for the same chief complaint with a negative lumbar computerized tomography scan and right hip x-ray nine months prior to presentation and a negative lumbar spine x-ray three months prior to presentation. Baseline laboratory results were not obtained until presentation in outpatient clinic and MRI was not performed in prior clinical settings due to symptoms being listed as non-emergent. MRI was obtained following significant functional decline as well as recent lab work which indicated underlying malignancy.

Conclusions: In the setting of worsening chronic joint pain, baseline physiological status should be established with annual laboratory work that can reveal less common and more nefarious medical etiologies such as malignancy.