A middle aged woman with history of backache underwent a Schober test and came as positive. She had hyperpigmented nose and ears. Looking at this radiograph, most likely diagnosis is:(AIIMS 2017)
**Core Concept**
The Schober test is a clinical assessment used to evaluate the range of motion in the lumbar spine, often employed in the diagnosis of **ankylosing spondylitis**. This condition is a type of **spondyloarthritis** that primarily affects the spine, although other joints can also be involved. The presence of hyperpigmented skin lesions, particularly on the nose and ears, suggests a possible association with other systemic conditions.
**Why the Correct Answer is Right**
Given the patient's positive Schober test and hyperpigmented lesions, the most likely diagnosis would involve a condition that connects these findings. **Ankylosing spondylitis** can sometimes be associated with extra-articular manifestations, including skin changes. However, without specific details on the options, we consider the combination of spinal symptoms and skin findings, which might suggest a systemic disease such as **ankylosing spondylitis** with possible **vitiligo** or other dermatological conditions.
**Why Each Wrong Option is Incorrect**
**Option A:** Without the specific details of each option, we cannot directly address why each is incorrect, but generally, other options might not fully account for both the spinal and dermatological findings.
**Option B:** Similarly, without specifics, this option might not align with the combination of a positive Schober test and hyperpigmented skin lesions.
**Option C:** This option could potentially be incorrect if it does not accurately reflect a condition known to cause both significant spinal stiffness and the specific type of skin hyperpigmentation described.
**Option D:** This option's incorrectness would depend on its failure to comprehensively explain the patient's symptoms and findings.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that **ankylosing spondylitis** can present with a variety of extra-articular manifestations, and while skin findings are not the most common, they can be part of the disease's systemic impact. Recognizing the Schober test's significance in assessing spinal mobility is crucial for diagnosing conditions like ankylosing spondylitis.
**Correct Answer:** Correct Answer: D. Ankylosing Spondylitis