Cheema Rabia, Chang-Miller April, Aslam Fawad
Department of Medicine, St. Mary's Hospital, Waterbury, CT, USA.
Department of Medicine, Frank H. Netter MD School of Medicine, North Haven, CT, USA.
Am J Case Rep. 2019 May 8;20:659-663. doi: 10.12659/AJCR.915564.
BACKGROUND Fibromyalgia (FM) is a common disorder of diffuse musculoskeletal pain. It is distinctly different from polymyalgia rheumatica (PMR), a disease seen in people over the age of 50 years. Hallmark features of PMR are the presence of elevated erythrocytes sedimentation rate (ESR) and/or C-reactive protein (CRP). These markers are normal in FM. Obesity in itself can be associated with elevated CRP and ESR, and when obese patients present with myalgia and elevated inflammatory markers, diagnostic confusion can ensue. CASE REPORT We describe a case of 38-year-old female with diffuse musculoskeletal pain and elevated ESR and CRP who was initially misdiagnosed with PMR and responded partially to steroids. She developed severe adverse effects from chronic steroid use. She was ultimately diagnosed with FM. CONCLUSIONS We highlight features to help clinicians avoid the pitfall of diagnosing PMR in young obese patients with FM and elevated inflammatory markers. In this case report, we discuss the features of FM, PMR, PMR-like symptoms presentation, and the association of obesity with elevated inflammatory markers.
纤维肌痛（FM）是一种常见的弥漫性肌肉骨骼疼痛疾病。它与风湿性多肌痛（PMR）明显不同，后者常见于50岁以上人群。PMR的标志性特征是红细胞沉降率（ESR）和/或C反应蛋白（CRP）升高。这些指标在FM中是正常的。肥胖本身可与CRP和ESR升高相关，当肥胖患者出现肌痛和炎症指标升高时，可能会导致诊断混淆。病例报告：我们描述了一例38岁女性，患有弥漫性肌肉骨骼疼痛，ESR和CRP升高，最初被误诊为PMR，对类固醇治疗有部分反应。她因长期使用类固醇出现了严重不良反应。她最终被诊断为FM。结论：我们强调一些特征，以帮助临床医生避免在患有FM且炎症指标升高的年轻肥胖患者中误诊为PMR的陷阱。在本病例报告中，我们讨论了FM、PMR、类似PMR症状表现的特征，以及肥胖与炎症指标升高的关联。
