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[Low back pain and MRI-abnormalities: atypical polymyalgia rheumatica]
Nick Wlazlo1, Bert Bravenboer, Rik Pijpers
1Catharina Ziekenhuis, Afd. Neurologie, Eindhoven, The Netherlands. nickwlazlo@gmail.com
Nederlands Tijdschrift Voor Geneeskunde
|January 26, 2011
Summary
Polymyalgia rheumatica (PMR) can present atypically, sometimes requiring advanced imaging like PET-CT for diagnosis. Prompt treatment with prednisone effectively reduced symptoms and inflammation in this case.
Area of Science:
- Rheumatology
- Diagnostic Imaging
Background:
- Polymyalgia rheumatica (PMR) is characterized by characteristic clinical symptoms.
- Atypical presentations of PMR can pose diagnostic challenges.
Observation:
- A 64-year-old male presented with refractory low back pain and inflammatory spinal lesions on MRI.
- Initial antibiotic treatment was ineffective, prompting further investigation.
- PET-CT revealed widespread abnormalities in the shoulders, back, and hips, suggesting PMR.
Findings:
- Treatment with prednisone rapidly alleviated the patient's pain.
- Follow-up MRI demonstrated significant reduction in inflammatory changes within 3 months.
- Imaging findings, including shoulder and hip abnormalities, are crucial in diagnosing atypical PMR.
Implications:
- This case underscores the utility of advanced imaging modalities like PET-CT in diagnosing challenging PMR cases.
- Recognizing potential imaging findings beyond typical joint involvement, such as interspinous bursitis, is important for accurate diagnosis and management of PMR.
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