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Published on: August 9, 2011
A Twist in the Tale: The Unmasking of Listeria in a PMR Case
Ghassan Al-Qaysi1, Viswaja Kaja2, Rishitha Anumola3
1Division of Rheumatology Virginia Tech Carilion School of Medicine Roanoke Virginia USA.
Abstract:
In general, an older patient presenting with proximal muscle pain and fatigue, with elevated inflammatory markers, would generally result in an extensive evaluation. If this is negative, it would be reasonable for a diagnosis of polymyalgia rheumatica (PMR) to be made and the patient referred to rheumatology. Our patient presented myalgia in proximal muscles and an elevated sedimentation rate. He was treated with steroids for polymyalgia rheumatica with improvement. He was subsequently admitted to the intensive care unit (ICU), where a diagnosis of Listeria monocytogenes sepsis was made and treated. With antibiotics he improved and was discharged from the hospital. This Case Report underscores the importance of considering unusual infections when entertaining a systemic autoimmune rheumatic disease (SARD) as the cause of systemic inflammatory response syndrome.
Insights
An older patient with muscle pain and fatigue was initially diagnosed with polymyalgia rheumatica (PMR). However, Listeria sepsis was later identified, highlighting the need to consider infections in systemic inflammatory response syndrome.
Area of Science:
- Rheumatology and Infectious Diseases
Background:
- Proximal muscle pain, fatigue, and elevated inflammatory markers in older adults often prompt evaluation for polymyalgia rheumatica (PMR).
- Atypical presentations can mimic autoimmune conditions, necessitating a broad differential diagnosis.
Purpose of the Study:
- To report a case where polymyalgia rheumatica (PMR) symptoms were initially attributed to an autoimmune process.
- To emphasize the importance of considering unusual infections in the differential diagnosis of systemic inflammatory response syndrome (SIRS).
Main Methods:
- A case report detailing the clinical presentation, diagnostic process, and treatment of a patient with initially suspected PMR.
- Review of the patient's medical history, laboratory findings, and response to treatment.
Main Results:
- The patient presented with proximal myalgia and elevated sedimentation rate, responding to steroid treatment consistent with PMR.
- Subsequent intensive care unit admission led to the diagnosis of Listeria monocytogenes sepsis.
- Treatment with antibiotics resulted in patient improvement and hospital discharge.
Conclusions:
- Systemic autoimmune rheumatic diseases (SARDs) should be considered in patients with SIRS.
- Unusual infections, such as Listeria sepsis, can mimic autoimmune rheumatic diseases and must be ruled out.
- A comprehensive diagnostic approach is crucial for accurate diagnosis and effective management of complex systemic inflammatory conditions.
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