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Ankylosing spondylitis presenting with enthesitis at an uncommon site and fever of unknown origin
  1. Naoki Kanda1,
  2. Koichi Takeda2,
  3. Shuji Hatakeyama1,3 and
  4. Masami Matsumura1
  1. 1 General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Japan
  2. 2 Infectious Diseases, Cancer Institute Hospital of JFCR, Koto-ku, Japan
  3. 3 Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
  1. Correspondence to Dr Naoki Kanda, naok16knd{at}


A 58-year-old man presented with a 2-month history of arthralgia and bilateral temporal region pain, and a 1-month history of fever. He had had refractory neck pain since his 20s. Reduced cervical and lumbar mobility was observed. Radiographs of cervical and thoracic vertebrae disclosed syndesmophytes. Pelvic radiographs showed sclerosis in the right sacroiliac joint and ankylosis in the left sacroiliac joint. MRI with contrast enhancement showed enthesitis in the upper extremities and enhancement in the bilateral temporal muscle, which indicated enthesitis of temporal muscle. He was diagnosed with ankylosing spondylitis based on the limitation in mobility of the lumbar spine and radiographic findings. To the best of our knowledge, this is the first report describing enthesitis of the temporal muscle. This case highlights that ankylosing spondylitis can be accompanied with enthesitis at the temporal muscle and fever of unknown origin at the initial presentation.

  • anklosing spondylitis
  • musculoskeletal syndromes

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  • Contributors NK was an attending physician of this patient, and wrote the initial draft of the manuscript. KT contributed to interpretation of data. SH and MM discussed, checked and revised the manuscript. All authors approved the final version of the manuscript, and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.