A 38-Year-Old Man Is Evaluated Due to a 2-Year History

A 38-year-old man is evaluated due to a 2-year history of gradually worsening low back pain, bilateral buttock pain, and stiffness.  Symptoms are worse in the morning and relieved with stretching and hot showers.  The patient also has fatigue but no fever, chills, night sweats, or weight loss.  Vital signs are normal.  The patient appears healthy but has a stooped walking posture.  Deep palpation over the lumbar spine at the midline and both sacroiliac joints elicits tenderness.  Erythrocyte sedimentation rate is 75 mm/hr.  Which of the following pathologic findings is most likely causing this patient's symptoms?

A) Areas of bony erosions and new bone formation
B) Areas of spindle cells and dysplastic bone
C) Areas of trabecular and cortical bone thickening
D) Disc protrusion and thickening of the ligamentum flava
E) Plasma cell infiltrate in bone marrow

Correct Answer:

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