{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T18:02:31Z","timestamp":1770832951005,"version":"3.50.1"},"reference-count":15,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>An 89-year-old male developed a persistent high fever (around 39 \u00b0C) approximately two weeks following endoscopic reduction of sigmoid volvulus. He had no history of hypercalcemia but was using diuretics and proton pump inhibitors. Renal and thyroid status were normal. He was largely bedridden and asymptomatic except for fever. Laboratory tests demonstrated elevated C-reactive protein (4.75 mg\/dL), but some tumor markers (including CEA, CA19-9, and CA125), anti-nuclear antibodies, MPO-ANCA, PR3-ANCA, \u03b2-D-glucan, and interferon-gamma release assay were all negative. Urinalysis was unremarkable. Blood cultures obtained from two sets were negative. Chest\u2013abdomen\u2013pelvis contrast-enhanced computed tomography (CT), and echocardiography did not reveal any evident neoplastic lesions or focal sites of infection. Despite various antibiotic therapies, the patient\u2019s spike fever persisted for nearly one month, leading to a diagnosis of fever of unknown origin (FUO). The patient experienced partial symptomatic relief with corticosteroid therapy, though mild fever continued. Two months after the volvulus onset, diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) was performed, revealing hyperintensities at the right sternoclavicular joint, leading to a diagnosis of sternoclavicular arthritis. Neck CT revealed calcification in this joint. Despite difficulty in joint fluid analysis, low infection risk and the patient\u2019s prolonged bedridden state and advanced age led to suspicion of pseudogout. Nonsteroidal anti-inflammatory drugs relieved fever and normalized inflammatory markers. DWIBS may be a valuable tool for detecting potential focus sites in FUO.<\/jats:p>","DOI":"10.3390\/diagnostics15162032","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T15:53:27Z","timestamp":1755100407000},"page":"2032","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Uncovering Sternoclavicular Arthritis, Suspected Pseudogout, in a Fever of Unknown Origin by Whole-Body MRI"],"prefix":"10.3390","volume":"15","author":[{"given":"Maho","family":"Hayashi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Fukui General Hospital, 55-16-1 Egami-cho, Fukui 910-8561, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3446-0913","authenticated-orcid":false,"given":"Koji","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami-cho, Fukui 910-8561, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2947-9743","authenticated-orcid":false,"given":"Mamiko","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami-cho, Fukui 910-8561, Japan"},{"name":"Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami-cho, Fukui 910-3190, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiko","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fukui General Hospital, 55-16-1 Egami-cho, Fukui 910-8561, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6305-2444","authenticated-orcid":false,"given":"Yasutaka","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami-cho, Fukui 910-3190, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"ref_1","first-page":"275","article-title":"Diffusion weighted whole body imaging with background body signal suppression (DWIBS): Technical improvement using free breathing, STIR and high resolution 3D display","volume":"22","author":"Takahara","year":"2004","journal-title":"Radiat Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Nakata, M., Yokota, N., and Kenzaka, T. (2023). Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression was useful in a patient with isolated myocardial abscess confined to the right atrial wall: A case report. BMC Cardiovasc. Disord., 23.","DOI":"10.1186\/s12872-023-03366-w"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Suzuki, A., Hayashi, K., Sato, M., Nakaya, Y., Miura, T., Takaku, N., Iwasaki, T., and Kobayashi, Y. (2025). Visualizing Aortic Inflammation by Diffusion-Weighted Whole-Body Imaging with Background Body Signal Suppression (DWIBS). Diagnostics, 15.","DOI":"10.3390\/diagnostics15091151"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3298","DOI":"10.21037\/qims-24-1861","article-title":"Comparison of diffusion-weighted whole-body magnetic resonance imaging and abdominal ultrasonography versus contrast-enhanced computed tomography in diagnosing acute focal bacterial nephritis: A retrospective cohort study","volume":"15","author":"Nakata","year":"2025","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"743","DOI":"10.3892\/etm.2017.4567","article-title":"Diagnosis of complications associated with acute cholecystitis using computed tomography and diffusion-weighted imaging with background body signal suppression\/T2 image fusion","volume":"14","author":"Tomizawa","year":"2017","journal-title":"Exp. Ther. Med."},{"key":"ref_6","first-page":"e83866","article-title":"A case of synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome with myeloperoxidase anti-neutrophil cytoplasmic antibody: Exploring an association or coincidence","volume":"17","author":"Kimura","year":"2025","journal-title":"Cureus"},{"key":"ref_7","first-page":"137","article-title":"Fever of unknown origin in adults","volume":"105","author":"David","year":"2022","journal-title":"Am. Fam. Physician"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"ofae298","DOI":"10.1093\/ofid\/ofae298","article-title":"Recommendations for Updating Fever and Inflammation of Unknown Origin from a Modified Delphi Consensus Panel","volume":"11","author":"Wright","year":"2024","journal-title":"Open Forum Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Andrej Tavakoli, A., Reichert, M., Blank, T., Dinter, D., Weckbach, S., Buchheidt, D., Schoenberg, O.S., and Attenberger, U. (2020). Findings in whole body MRI and conventional imaging in patients with fever of unknown origin\u2014A retrospective study. BMC Med. Imaging, 20.","DOI":"10.1186\/s12880-020-00493-0"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s12969-020-00433-w","article-title":"Usefulness of magnetic resonance enterography in detecting signs of sacroiliitis in young patients with inflammatory bowel disease","volume":"18","author":"Giani","year":"2020","journal-title":"Pediatr. Rheumatol. Online J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1016\/j.avsg.2019.04.044","article-title":"Potential application of diffusion-weighted whole-body imaging with background body signal suppression for disease activity assessment in Takayasu arteritis\u2014In search of the \u201cgolden mean\u201d: Case report","volume":"61","author":"Davidovic","year":"2019","journal-title":"Ann. Vasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.2169\/internalmedicine.1792-18","article-title":"Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) as a novel imaging modality for disease activity assessment in Takayasu\u2019s arteritis","volume":"58","author":"Oguro","year":"2019","journal-title":"Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"521","DOI":"10.2169\/internalmedicine.53.1582","article-title":"Pseudogout of the sternoclavicular joints","volume":"53","author":"Hanai","year":"2014","journal-title":"Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1136\/ard.2010.139105","article-title":"European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: Terminology and diagnosis","volume":"70","author":"Zhang","year":"2011","journal-title":"Ann. Rheum. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1093\/rheumatology\/kes204","article-title":"Risk factors for pseudogout in the general population","volume":"51","author":"Rho","year":"2012","journal-title":"Rheumatology"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/16\/2032\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:26:51Z","timestamp":1760034411000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/16\/2032"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,13]]},"references-count":15,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["diagnostics15162032"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15162032","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,13]]}}}