Abstract Body

Background

Polymyalgia rheumatica (PMR) is chronic inflammatory condition that affects manly elderly individuals. The diagnosis is based in symptomatology and exclusion of potential diseases.

Methods

Male, 71 years old. Personal history: arterial hypertension, diabetes mellitus, heart failure, atrial fibrillation, sleep apnea. Medication: furosemide 40mg, Carvedilol 25mg, spironolactone 100mg, Metformin 500mg, Rivaroxaban 20mg.

The patient resorted to family doctor (FD) due to myalgias, asthenia and worsening dyspnea pattern. Blood test revealed normochromic normocytic anemia.

Symptoms worsened and patient went to hospital. There, due to febrile peaks (38.9ºC) and absence of an outbreak of infection, were collected blood cultures and started ceftriaxone empirically. Later was detected aortic murmur and a traumatic wound in the lower limb. The patient started clindamycin and was hospitalized with suspicion of infective endocarditis vs erysipelas. Analytically: Hemoglobin 9.6g/dL, without leukocytosis, PCR 20.21mg/dl, VS 116mm. Blood cultures were negative and digestive endoscopies normal. After 10 days of antibiotics, PCR decreased (17mg/dl), maintained VS 100mm and Hemoglobin reached 8.4mg/dl. The symptoms evolved into significant fatigue, cervical and scapular arthralgias, proximal myalgia and occipital headache. Observed by Rheumatology, PMR diagnosis was considered and started prednisolone. Autoimmune study was negative.

Results

After 6 days of high-dose corticotherapy there was significant improvement of symptomatology and patient was discharged with prednisolone 40mg maintenance dose.

Conclusions

PMR diagnosis can be a challenge for the family doctor. The identification of fast and marked deterioration of the general condition as well as the therapeutic test with corticotherapy can avoid an unnecessary investigation.