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An 85-year-old man was admitted to the Department of Orthopaedics with fever, polyarthralgia and back pain. Laboratory evaluation was notable for a C-reactive protein (CRP) level of 21.2 mg/dl (normal range, <0.3 mg/dl) and a leukocyte count of 13 400 cells/μl, however, no bacteria were detected in his blood culture. T2-weighted MRI of the lumbar spine revealed a high intensity in the L2–L3 disc (fig 1), and he was diagnosed as having suppurative spondylodiscitis and treated using antibiotics. However, his symptoms and serum CRP level (8.0 mg/dl) were not ameliorated, and the high intensity in the L2–L3 disc on lumbar spinal MRI still existed 2 weeks after the start of antibiotic therapy; he was then referred to our department. Symmetrical gallium-67 uptake in joints including shoulders and pelvic girdle on scintigraphy (fig 2), and elevated levels of serum matrix metalloproteinase 3 (136 ng/ml; normal range, 17.3–59.7 ng/ml) and vascular endothelial growth factor (1260 pg/ml; normal range, <115 pg/ml) as a synovial derived marker of inflammation suggested the presence of polymyalgia rheumatica (PMR).1,2 Gallium-67 uptake was also observed in the lumbar spine around L3, and gallium-67 uptake in the posterior image was more intense than that in the anterior image, suggesting the existence of spondylodiscitis. The patient’s clinical and biochemical characteristics showed a good agreement with the PMR diagnostic criteria.3 Corticosteroid therapy (20 mg/day) promptly ameliorated his symptoms and serum CRP (0.3 mg/dl at 10 days after corticosteroid therapy started), supporting the diagnosis of PMR.
This patient is the first case with polymyalgia rheumatica (PMR) who manifested aseptic spondylodiscitis.
PMR is occasionally accompanied with fever and an elevated serum C-reactive protein (CRP) level.
As this condition mimics infectious spondylodiscitis, it is important to recognise aseptic spondylodiscitis in PMR.
Competing interests: None.
Patient consent: Patient/guardian consent was obtained for publication.