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A 79-year-old woman had abrupt onset of pain in the shoulders, neck, and back for one month.
She had hyperlipidemia and three years before admission, simvastatin was replaced with atorvastatin because of myalgias. Seven months before admission, pain developed over the lateral chest wall bilaterally, extending from the axillas to the middle of her rib cage. The area was sore to the touch, but not positional. She also felt a lump in her throat when swallowing and had pain that radiated to her right ear. She discontinued atorvastatin, and the symptoms gradually resolved. One to two months later, she resumed atorvastatin, and the symptoms recurred, along with fatigue and reduced excerise tolerance.
One month before admission, ezetimibe was added to her medications, and the dose of atorvastatin was reduced from 20 mg to 10 mg per day. Two days later, bilateral shoulder aches and neck and back pain developed. She stopped taking both ezetimibe and atorvastatin, but the symptoms persisted.
Eleven days before admission, she saw her primary care physician. She had what she described as "unbearable" pain in the morning and difficulty arising from her bed and from chairs, a sore throat, and pain over the lateral aspect of the chest wall bilaterally, extending from the axillas to the middle of her rib cage. ESR was 90 mm/hr.
Four days before admission, her PCP started prednisone 20 mg per day. The pain and weakness improved, but two days before admission progressively worsening shortness of breath developed with minimal exertion and with prolonged speaking.
( case is editted from source)
Does this patient meet diagnsotic criteria for PMR?
What about the poor response to prednisone?
What about the cough and sore throat?