title: A case of epidemic myalgia with symptoms resembling acute purulent spondylitis and discitis.
abstract: Epidemic myalgia is a disease that presents with fever and extreme myalgia of the trunk due to an acute enterovirus infection. The trunk pain is mainly in the chest or in the epigastrium. We aimed to highlight a case of epidemic myalgia where initial diagnosis needed differentiation from acute purulent spondylitis and discitis.
  
  
  
  A 33-year-old woman presented with fever, chills, and acute episodes of low back pain. The sole unusual finding was pain upon spinal percussion, limited to the 4th and 5th lumbar vertebrae. Spinal MRI showed no abnormality. Paired serum samples from disease days 4 and 15 showed a significant increase in coxsackievirus B3-neutralizing antibodies. Based on this course, we diagnosed epidemic myalgia.
  
  
  
  Epidemic myalgia should be considered when differentiating acute low back pain accompanied by fever.
authors.affiliation: Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan. smile.kenzaka@jichi.ac.jp.|Department of Internal Medicine, Hyogo Prefectural Kaibara Hospital, Tamba, Japan. smile.kenzaka@jichi.ac.jp.
authors.forename: Tsuneaki
authors.initials: T
authors.lastname: Kenzaka
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Kaibara Hospital, Tamba, Japan.
authors.forename: Yukariko
authors.initials: Y
authors.lastname: Hida
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Kaibara Hospital, Tamba, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Kaibara Hospital, Tamba, Japan.
authors.forename: Hozuka
authors.initials: H
authors.lastname: Akita
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D015299:Discitis / Q000175:diagnosis; D005260:Female; D006801:Humans; D011000:Pleurodynia, Epidemic / Q000175:diagnosis* / Q000821:virology
keywords: Coxsackievirus; Epidemic myalgia; Low back pain; Purulent discitis; Purulent spondylitis