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We describe a case of acute poisoning in a 51-year-old female patient who presented to the Emergency Department with weakness, anxiety, dry mouth, bilateral mydriasis and lid drop. In differential diagnosis, botulism, Guillain-Barré syndrome and myasthenia gravis were considered, as well as cerebral haematoma because of a cranial injury a week before. Symptoms, which resolved within 12 h without any therapy, were instead related to the ingestion of lupin seeds.

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No data exist about the possibility that vertebral fracture in PMR patients could be independent of steroid therapy. For this reason, we aimed to investigate this topic by a case cohort study with a 1-year follow-up for each patient. We selected ten consecutive patients who experienced vertebral fractures (VF-group) during the Wrst month of 1-year follow-up period and without any other signiWcant associated condition. As a control group we studied ten control patients, without vertebral fractures and with a follow-up of 1 year, randomly selected among a larger group of patients aVected by polymyalgia rheumatica. The following data were analysed: eritrosedimention rate (ESR), visual analogical scale score (VAS), methyprednisolone daily dosage. Each patient had been monthly evaluated by the aforementioned clinical and laboratoristic parameters during the 1-year follow-up period. The VFgroup resulted with a higher and statistically signiWcant median corticosteroid 12-month total dosage [mean 3,480 mg (95%CI 2,805-3,030) vs. 2,760 mg (2,666.25-3,247.5)]. The VF-group had statistically signiWcant higher ESR and VAS AUC when compared to control group (median ESR AUC, 484.75 vs. 288.25; P = 0.0001; median VAS AUC, 70.75 vs. 43.5 P < 0.0001); ESR at the baseline (cut-oV >80 mm) showed a speciWcity of 90% (95%CI 56-100) and sensitivity of 70% (95%CI 35-93). VAS diVerence from Wrst to second month (cut-oV ·3) showed a speciWcity of 90% (95%CI 56-100) and sensitivity of 80% (95% CI 44-97). Our results point out that vertebral fracture might be predicted from commonly used laboratory (ESR) and clinical (VAS) Wndings.