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Kanzaki A, Matsui K, Sukenaga T, Mase K, Nishioka A, Tamori T, Kataoka S, Konya H, Mizutani S, Takeda A, Koseki M, Nishiura T, Koyama H, Sano H. Fever of unknown origin following parathyroidectomy prior to onset of typical polymyalgia rheumatica symptoms: a case report. Int J Gen Med 2018; 11:307-311. [PMID: 30038516 PMCID: PMC6052921 DOI: 10.2147/ijgm.s159364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Polymyalgia rheumatica (PMR) is a disease commonly seen in elderly individuals, however, the etiology has not been reported. Typical clinical features include bilateral shoulder pain and morning stiffness, while serologic autoantibody test findings are negative. Approximately 40%–50% of affected patients present with low-grade fever, fatigue, and appetite loss, which we often experience in the field of general medicine, and thus, the condition should not be given low priority. However, knowledge regarding such constitutional manifestations is also limited. We encountered an elderly woman with a fever of unknown origin that developed following a parathyroidectomy for a single parathyroid adenoma, after which severe shoulder pain and morning stiffness emerged, leading to a diagnosis of PMR. The fever developed several days prior to appearance of severe pain, which is an uncommon presentation in PMR cases. Our patient had low-grade inflammation without pyrexia prior to the surgery, which might have been an important reason for the accelerated immoderate immune activation leading to PMR induced by surgery in this case. Furthermore, she was infected with the influenza A virus 3 weeks before coming to us. Some reports have suggested a relationship between the influenza virus or vaccine and PMR. It is difficult to conclude regarding the definite trigger in our patient, though the details of this case should be helpful for a better understanding of the disease.
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Affiliation(s)
- Akinori Kanzaki
- Department of Internal Medicine, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan, .,Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan,
| | - Kiyoshi Matsui
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tadahiko Sukenaga
- Department of Internal Medicine, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan, .,Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan,
| | - Koushi Mase
- Department of Internal Medicine, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan,
| | - Aya Nishioka
- Department of Internal Medicine, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan,
| | - Tomoharu Tamori
- Department of Surgery, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan
| | - Seiko Kataoka
- Department of Internal Medicine, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan,
| | - Hiroyuki Konya
- Department of Internal Medicine, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan,
| | - Shin Mizutani
- Department of Surgery, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan
| | - Akira Takeda
- Department of Internal Medicine, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan,
| | - Masato Koseki
- Department of Internal Medicine, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan,
| | - Tetsuo Nishiura
- Department of Internal Medicine, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan,
| | - Hidenori Koyama
- Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan,
| | - Hajime Sano
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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