A case of type 2 diabetes with polymyalgia rheumatica accompanied by marked prothrombin time-international normalized ratio elongation

Abstract

The patient described in this case was an 81-year-old female who had undergone aortic valve replacement because of aortic stenosis 5 years prior to the present admission. Since then, she had been taking oral warfarin (3.5 mg/day). She also had a 4-year history of diabetes mellitus and was taking oral anti-diabetic medications. Her HbA1c was 8.0%. She had recently developed leg edema, and was referred to our department to receive a detailed examination and to improve her blood glucose control. Her blood sample revealed a marked elongation of the PT-INR (9.8), so she was urgently hospitalized. After admission, vitamin K2 and heparin were administered, and her warfarin dose was later adjusted, resulting in the improvement of her PT-INR. Several weeks before admission, the patient had complained of a slight fever, morning stiffness, and symptoms of bilateral brachium and thigh myalgia. She was diagnosed with polymyalgia rheumatica (PMR). Oral treatment with predonine (10 mg/day) was started, and the symptoms of PMR were alleviated markedly the following day. For blood glucose control, insulin therapy was started. We speculate that the sudden increase in inflammation and malnutrition following the onset of PMR resulted in the marked PT-INR elongation in this case.