Denne et al. Journal of Medical Case Reports 2011, 5:440 http://www.jmedicalcasereports.com/content/5/1/440 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Lumbar disc herniation in three patients with cystic fibrosis: a case series Christian Denne1*, Anna E Vogl-Voswinckel1, Harald Wurmser1, Marc Steinborn2, Manfred Spaeth3, Armin Gruebl1 and Stefan Burdach1 Abstract Introduction: To date, lumbar disc herniation has not been reported in the context of cystic fibrosis even though back pain and musculoskeletal problems are very common in patients with cystic fibrosis. Case presentation: We report on three patients with cystic fibrosis who experienced lumbar disc herniation in the course of their disease at ages 19 to 21 years (a 22-year-old Caucasian man, a 23-year-old Caucasian man, and a 21-year-old Caucasian woman). Our third patient eventually died because of her deteriorated pulmonary situation, which was influenced by the lumbar disc herniation as it was not possible for her to perform pulmonary drainage techniques properly because of the pain. Conclusions: Lumbar disc herniation can lead to a vicious cycle for patients with cystic fibrosis as it may promote pulmonary infections. This report highlights the need to investigate patients correctly. Introduction Cystic fibrosis (CF) is a lethal chronic pulmonary disease with recurrent acute infective exacerbations, inevitably leading to progressive bronchiectasis and combined venti- latory disorders [1]. With the improved survival rates in recent decades, CF may also be commonly associated with relevant painful conditions caused by complications of the illness and also by therapy itself, which may cause addi- tional suffering [2,3]. Back pain is a chief complaint in patients with cystic fibrosis [4]. It is often due to vertebral fractures as a consequence of a decreased bone mineral density due to use of steroids [5]. Rheumatoid arthritis, spondyloarthropathies, and posture abnormalities such as kyphosis have also been reported in association with CF [6]. Whereas many papers focus on pain in patients with CF, studies on lumbar disc herniation (LDH) in patients with CF have not been reported to date [7]. Case presentation We report on three patients with clinically symptomatic and radiologically proven LDH from our CF clinic. The * Correspondence: christian.denne@lrz.tum.de 1Department of Pediatrics, Kinderklinik München Schwabing, Klinikum Schwabing StKM GmbH and Klinikum Rechts der Isar (AöR) of the Technical University (TU) München, Munich, Germany Full list of author information is available at the end of the article CF clinic is part of the Department of Pediatrics. The age structure of patients (children, adults) is mixed. In all, 24 of a total of 46 patients from the clinic were older than 18 years according to the Cystic Fibrosis Ambulance System (CFAS) data. The mean age at diag- nosis of LDH was 20.5 years. The point prevalence of LDH was 6.5% in our clinic in the year of the case pre- sentation, with respect to all patients. With respect only to adults, the point prevalence was 12.5%. One of these three patients had a neurosurgical decompression opera- tion. Lung function parameters (as shown by forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)) were variable. Family history for LDH was positive in two patients. Case 1 Patient 1 was a 22-year-old athletic and muscular Cauca- sian man (delta F 508 homozygous, Pseudomonas positive) with good lung function parameters (Table 1), in whom LDH was diagnosed at an age of 21 years. He had experi- enced recurrent back pain, predominantly lumbalgia, for about two years before the diagnosis of LDH. It was trea- ted with non-steroidal anti-inflammatory drugs (NSAIDs) by our patient. Two weeks before the LDH diagnosis was made via lumbar nuclear magnetic resonance (NMR) scans, his lumbalgia increased sharply, finally with inguinal © 2011 Denne et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.