ABSTRACT
A 64-year-old woman presented to the emergency department complaining of lower back and bilateral hip pain. She explained that she had noticed that she had lower back pain around 6 months ago, following exertion or short periods of immobility. The lower back pain was now present for most of the day and was becoming increasingly severe. She also described bilateral hip pain that had been present for around 3–4 months. This was initially only present when she was walking upstairs or on a gradient but was now limiting her mobility indoors. She had been unable to attend her job as a seamstress for the past 2 months due to the worsening pain. She denied any preceding injuries. She had no symptoms of fever. On direct questioning, she described night sweats and 7 kg unintentional weight loss within the past 4–6 weeks. She denied altered sensation or episodes of incontinence. Her past medical history included pulmonary tuberculosis, which was treated 2 years earlier, and vitamin D deficiency. She took intermittent courses of cholecalciferol. She looked after her grandchildren on weekdays. She travelled to Bangladesh every summer and stayed with family in Dhaka for 4 weeks. She had last travelled there 9 months earlier. She denied smoking tobacco or drinking alcohol.
