{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T17:27:41Z","timestamp":1780853261447,"version":"3.54.1"},"reference-count":13,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,7,23]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>A 58-year-old man presented with a 2-month history of arthralgia and bilateral temporal region pain, and a 1-month history of fever. He had had refractory neck pain since his 20s. Reduced cervical and lumbar mobility was observed. Radiographs of cervical and thoracic vertebrae disclosed syndesmophytes. Pelvic radiographs showed sclerosis in the right sacroiliac joint and ankylosis in the left sacroiliac joint. MRI with contrast enhancement showed enthesitis in the upper extremities and enhancement in the bilateral temporal muscle, which indicated enthesitis of temporal muscle. He was diagnosed with ankylosing spondylitis based on the limitation in mobility of the lumbar spine and radiographic findings. To the best of our knowledge, this is the first report describing enthesitis of the temporal muscle. This case highlights that ankylosing spondylitis can be accompanied with enthesitis at the temporal muscle and fever of unknown origin at the initial presentation.<\/jats:p>","DOI":"10.1136\/bcr-2019-230113","type":"journal-article","created":{"date-parts":[[2019,8,10]],"date-time":"2019-08-10T13:05:14Z","timestamp":1565442314000},"page":"e230113","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Ankylosing spondylitis presenting with enthesitis at an uncommon site and fever of unknown origin"],"prefix":"10.1136","volume":"12","author":[{"given":"Naoki","family":"Kanda","sequence":"first","affiliation":[{"name":"General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Takeda","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Cancer Institute Hospital of JFCR, Koto-ku, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuji","family":"Hatakeyama","sequence":"additional","affiliation":[{"name":"General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Japan"},{"name":"Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masami","family":"Matsumura","sequence":"additional","affiliation":[{"name":"General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,8,10]]},"reference":[{"key":"2025082802570403000_12.8.e230113.1","doi-asserted-by":"crossref","first-page":"2563","DOI":"10.1056\/NEJMra1406182","article-title":"Ankylosing spondylitis and axial spondyloarthritis","volume":"374","author":"Taurog","year":"2016","journal-title":"N Engl J Med"},{"key":"2025082802570403000_12.8.e230113.2","first-page":"560","article-title":"Primary ankylosing spondylitis: patterns of disease in a Brazilian population of 147 patients","volume":"28","author":"Sampaio-Barros","year":"2001","journal-title":"J Rheumatol"},{"key":"2025082802570403000_12.8.e230113.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2006.03.007"},{"key":"2025082802570403000_12.8.e230113.4","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-203582"},{"key":"2025082802570403000_12.8.e230113.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.6129.19-a"},{"key":"2025082802570403000_12.8.e230113.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2003.08.006"},{"key":"2025082802570403000_12.8.e230113.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0184323","article-title":"Fever as an initial manifestation of spondyloarthritis: a retrospective study","volume":"12","author":"Byun","year":"2017","journal-title":"PLoS One"},{"key":"2025082802570403000_12.8.e230113.8","first-page":"2286","article-title":"A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index","volume":"21","author":"Garrett","year":"1994","journal-title":"J Rheumatol"},{"key":"2025082802570403000_12.8.e230113.9","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1002\/art.39458","article-title":"Review: enthesitis: new insights into pathogenesis, diagnostic modalities, and treatment","volume":"68","author":"Kehl","year":"2016","journal-title":"Arthritis Rheumatol"},{"key":"2025082802570403000_12.8.e230113.10","doi-asserted-by":"publisher","DOI":"10.1136\/ard.46.3.197"},{"key":"2025082802570403000_12.8.e230113.11","doi-asserted-by":"publisher","DOI":"10.1136\/ard.55.4.268"},{"key":"2025082802570403000_12.8.e230113.12","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keh193"},{"key":"2025082802570403000_12.8.e230113.13","first-page":"954","article-title":"Definition of disease flare in ankylosing spondylitis: the patients' perspective","volume":"29","author":"Brophy","year":"2002","journal-title":"J Rheumatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-230113","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:57:12Z","timestamp":1756375032000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-230113"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":13,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,8,10]]},"published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1136\/bcr-2019-230113"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-230113","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8]]}}}