Case 19-1991

Presentation of CaseAn 80-year-old woman was admitted to the hospital because of increasing dyspnea, a cough, and an abnormal x-ray film of the chest.The patient was in a stable state of health until 10 months earlier, when stiffness and aching developed in proximal muscles; a diagnosis of polymyalgia rheumatica was made, and prednisone was begun, with prompt improvement and a decrease in the erythrocyte sedimentation rate. The patient required daily doses of insulin when the dose of prednisone was in excess of 20 mg daily. Six weeks before admission the dose of prednisone was reduced from 20 mg . . .