Neck pain and fever: what if it was a vertebral artery vasculitis?

A 64-year-old man was admitted for a neck pain, posterior headaches, fever (39°C), and an inflammatory syndrome lasting for six weeks (persistent elevation of C-reactive protein, around 200 mg/l). Because of a dry cough, a bronchopneumonia was firstly suspected: antibiotics were inefficient. The patient had no headache, no visual loss, no jaw or limb claudication. He had been diagnosed 3 years before with a polymyalgia rheumatica and was still treated with methotrexate. Because of the immunosuppressive drugs, we first suspected an infectious spondylodiscitis: the cervical Magnetic Resonance Imaging (MRI) only found cervical arthrosis. Bacteriological blood samples were sterile.