Bilateral Achilles tendinopathy of unknown origin responsive to corticosteroids: Case report

This case presents a rare instance of bilateral acute Achilles tendinopathy with an unidentified etiology, unreported in previous literature. Documented cases of bilateral Achilles tendon pathologies have typically been associated with specific medications, chronic enthesitis, or slowly progressing xanthomas.

A 55-year-old male presented with fever and bilateral Achilles tendon swelling and pain. Laboratory tests showed significantly elevated inflammatory markers (C-reactive protein 96.6 mg/L, erythrocyte sedimentation rate 69.0 mm/h) and elevated immunoglobulin A (4.44 g/L). Imaging revealed fusiform swelling with inflammatory changes in both Achilles tendons. The patient had a medical history of radical prostatectomy, chronic hepatitis B virus carrier status, and familial hypercholesterolemia.

Bilateral acute Achilles tendinopathy of unknown etiology. Its sensitivity to corticosteroid therapy, coupled with elevated serum immunoglobulin A, suggests a possible immune-mediated mechanism.

The core treatment was systemic corticosteroid therapy (methylprednisolone, dexamethasone). Empirical antibiotics were initially administered but were subsequently discontinued due to lack of evidence for infection and the marked efficacy of corticosteroid therapy. Concurrent medications included atorvastatin for hypercholesterolemia and entecavir for hepatitis B.

Symptoms resolved rapidly, with no recurrence during the 6-month follow-up period.

This case suggests a possible pathogenic role of immunoglobulin A-related immune mechanisms, though the lack of histopathological biopsy and genetic testing limited further etiological investigation. It offers a diagnostic and therapeutic reference for this rare bilateral acute Achilles tendinopathy, highlighting the potential role of immune factors in atypical tendinopathies.