Pleural and pericardial effusion in a patient with polymyalgia rheumatica.

Rheumatic polymyalgia (RPM) is a relatively common inflammatory disease of unknown origin that presents almost exclusively in adults over the age of 50. It is characterized by morning pain and stiffness in the cervical region and in the pectoral and pelvic girdles and may be associated with giant cell arteritis (GCA).1 Pleural or pericardial effusion is rare in patients with RPM without GCA and is exceptional as a manifestation of disease onset.2 The case of a 76-year-old woman who presented in the emergency room with fever (38 ◦C) is reported. She had had episodes of fever and pain in the pectoral girdle radiating to the cervical region over the previous 2 months. On one occasion, she had received oral corticosteroids in tapering schedule, with improvement. Physical examination revealed a systolic murmur in the aortic region and absent breath sounds in the base of the left lung. Clinical laboratory tests showed C-reactive protein 25.5 mg/dl and a small left pleural effusion was observed on the chest X-ray. The initial diagnosis was pneumonia with parapneumonic pleural effusion and the patient was hospitalized with empiric antibiotic therapy. Despite