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[A patient with polymyalgia rheumatica who exhibited fever as the main symptom for a long period]

Naoko Abe1, Hayato Yamauchi, Takanori Senba

  • 1Department of Internal Medicine, Hyogo Prefectural Awaji Hospital, Sumoto-city, Hyogo.

Ryumachi. [Rheumatism]
|December 5, 2002
PubMed

Insights

Polymyalgia rheumatica (PMR) can present with prolonged fever and elevated C-reactive protein (CRP) in elderly patients. This case highlights PMR as a potential cause of unexplained fever, even without initial muscle pain.

Area of Science:

  • Rheumatology
  • Internal Medicine

Background:

  • Polymyalgia rheumatica (PMR) is an inflammatory condition typically presenting with muscle pain and stiffness.
  • Fever can be an atypical or initial symptom of PMR, particularly in elderly individuals.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) may temporarily alleviate some symptoms, potentially complicating diagnosis.

Observation:

  • A 71-year-old male presented with prolonged fever and elevated C-reactive protein (CRP) without initial muscular complaints.
  • NSAID administration provided temporary relief from fever and lumbar pain, but fever persisted.
  • Development of shoulder and forearm muscular pain led to a diagnosis of PMR.

Findings:

  • The patient was diagnosed with polymyalgia rheumatica (PMR) based on Bird's criteria.
  • Treatment with prednisolone (PSL) rapidly resolved muscular pain.
  • The case demonstrates that PMR should be considered in the differential diagnosis of idiopathic fever in the elderly.

Implications:

  • This case expands the understanding of PMR presentation, emphasizing fever as a primary symptom.
  • Highlights the importance of considering PMR in elderly patients with persistent unexplained fever and elevated inflammatory markers.
  • Suggests a potential role for NSAIDs in masking or mimicking initial PMR symptoms.

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