Table 1.
Magnetic resonance imaging studies, symptoms and clinical signs, drug therapies and analysis in the patient’s history.
| CE-brain MRI | Day (*) | Symptoms and clinical signs | Radio-diagnostic investigations (other than brain MRI), drug therapies and analysis | ||
|---|---|---|---|---|---|
| I | 0 | ||||
| II | 12 | ||||
| S1 | Osteoarticular lumbar pain, “bone perceived as made of glass” | ||||
| III | 185 | ||||
| S2 | Restless legs, morning stiffness, severe leg and foot cramps, and “pins and needle” in foot | ||||
| IV | 264 | ||||
| S3 | Severe lower back aches and hip pain forced the patient to bed rest | ||||
| V | 377 | ||||
| L1 | MRI examination without contrast enhancement and X-ray scans revealed a lumbar disk-hernia | ||||
| VI | 441 | ||||
| VII | 689 | ||||
| VIII | 805 | ||||
| S4 | Anterior chest pain and tachycardia | ||||
| IX | 921 | ||||
| S5 | Recurrence of severe lumbar pain and progressive marked increase of morning stiffness | ||||
| L2 | A second lumbar MRI that revealed no disease progression | ||||
| X | 1082 | ||||
| XI | 1218 | ||||
| S6 | Severe exacerbation of lumbar aches and stiffness, forced bed rest several days | Anti-inflammatory pain killers were ineffective. Oral gabapentin administration had mild effect. | |||
| S7 | Flare-up of pain symptoms and lumbar stiffness | ||||
| XII | 1392 | ||||
| XIII | 1500 | ||||
| S8 | Onset of pain at the right shoulder and trapezium, stiffness presented at cervical site, pain at knees similar to the hips. Chest pain and tachycardia | ||||
| S9 | Unrefreshing sleep and severely fatigue unrelieved by rest. Exacerbating pain and severe stiffness impaired movements and forced the patient to bed. Depressive symptoms presented for the first time | Hypothesis of fibromyalgia. And referral to rheumatology unit | |||
| First rheumatology visit: physical examination, patient's history, and FM positive trigger point sensitivity. Requirement of blood analysis and pelvis MRI for excluding other rheumatic disorders and confirm FM diagnosis | Blood analysis (anti-nuclear antibodies, anti-nDNA antibodies research, anti-cyclic citrullinated peptide antibodies, anti-ENA antibodies, rheumatoid factor erythrocyte sedimentation rate, C-reactive protein, creatine kinase, and complete blood count) | ||||
| L3 | MRI scan of the pelvis without contrast enhancement | ||||
| Blood analyses negative. Other rheumatic pathologies such as spondilo-arthritis excluded based on MR images of the pelvis. | |||||
| XIV | 1715 | ||||
| F | Second rheumatology visit: FM diagnosis confirmed based on the presence of tender point sensitivity (14/18), widespread chronic pain for longer than 3 months, morning stiffness, non-restorative sleep, depression, anxiety, leg and foot cramps, chest pain, tachycardia, hypersensitivity to cold, “fibro-fog”, irritable bowel syndrome-constipation and hyperhidrosis. | ||||
| XV | 1959 |
CE-MRI, contrast-enhanced magnetic resonance imaging; S(i), symptoms.
L(i), radiological investigations of body compartments else than the brain.
(*) days from the first gadolinium-based administration.