ABSTRACT A 56-year-old man was admitted to hospital with fever, progressive fatigue, bilateral shoulder pain, paresthesias and stiffness after awakening. Differential diagnosis were several diseases such as rheumatoid arthritis, fibromyalgia and infectious spondylitis. Routine laboratory assays showed mild anemia and increased markers of inflammation. The worsening of clinical conditions led to performing a Computerized Tomography and a Cervical Magnetic Resonance Imaging which demonstrated an epidural liquid area in both left and anterior section of the spinal canal. Due to the high suspicious of tuberculosis we started a therapy with isoniazid, rifampicin, pyrazinamide and cyprofloxacin, even if the results of culture was negative for any kind of bacteria. This case-report underlines the difficulties of a correct diagnosis in a common symptom as back pain is.
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