PT  - JOURNAL ARTICLE
AU  - Naoki Kanda
AU  - Koichi Takeda
AU  - Shuji Hatakeyama
AU  - Masami Matsumura
TI  - Ankylosing spondylitis presenting with enthesitis at an uncommon site and fever of unknown origin
AID  - 10.1136/bcr-2019-230113
DP  - 2019 Aug 01
TA  - BMJ Case Reports
PG  - e230113
VI  - 12
IP  - 8
4099  - http://casereports.bmj.com/content/12/8/e230113.short
4100  - http://casereports.bmj.com/content/12/8/e230113.full
SO  - BMJ Case Reports2019 Aug 01; 12
AB  - 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.