[The dissecting aortic aneurysm associated with polymyalgia rheumatica: a case report]

Area of Science:

• Rheumatology
• Cardiovascular Medicine
• Internal Medicine

Background:

• Polymyalgia rheumatica (PMR) is an inflammatory condition typically associated with muscle pain and stiffness.
• Giant cell arteritis (GCA) is a known complication of PMR, though less common in Japanese populations.
• Dissecting aortic aneurysms are serious vascular conditions often linked to hypertension and connective tissue disorders.

Observation:

• A 55-year-old Japanese man presented with severe back pain, diagnosed as a dissecting aneurysm of the descending aorta.
• Following admission, he developed severe bilateral shoulder pain, progressing to involve his lower extremities.
• Neurological examination revealed no deficits, but laboratory tests showed an extremely high erythrocyte sedimentation rate.

Findings:

• The patient was diagnosed with polymyalgia rheumatica (PMR) based on clinical presentation and elevated inflammatory markers.
• Oral prednisolone administration led to a rapid and dramatic resolution of his muscle pain.
• The patient's initial presentation included a dissecting aortic aneurysm, a condition not typically directly linked to PMR.

Implications:

• This case suggests a potential, albeit rare, association between dissecting aortic aneurysms and polymyalgia rheumatica.
• Arteritis, a potential underlying factor in PMR, may contribute to vascular complications like aortic dissection.
• Physicians should consider the possibility of underlying arteritis in PMR patients presenting with severe vascular symptoms.