J Rheum Dis.  2012 Oct;19(5):299-301. 10.4078/jrd.2012.19.5.299.

A Case of Atypical Giant Cell Arteritis Presenting as a Fever of Unknown Origin

• Kang MI
• Park HJ
• Jeon HM
• Kang Y
• Lee SW
• Lee SK
• Park YB

• KMID: 1438541
• DOI: http://doi.org/10.4078/jrd.2012.19.5.299

Abstract

Giant cell arteritis (GCA) is a systemic vasculitis predominantly found in individuals of Northern European ancestry over 50 years of age. Typically it presents with new-onset persistent headache, claudication of jaws, and existence of an abnormal temporal artery. However, the diagnosis of GCA and the assessment of its activity remain challenging, especially in patients presenting with a variety of non-specific symptoms and laboratory tests. In those cases, 18F-fluorodeoxy-glucose positron emission tomography (18F-FDG-PET) is useful for the diagnosis of GCA. Recently, the number of foreign patients who visit domestic hospitals for medical care is increasing in Korea. Here-in, we report a Russian patient who was admitted to our hospital with fever of unknown origin (FUO). FUO study was performed to search for infection or malignancy and GCA was suspected by 18F-FDG-PET. The patient was eventually diagnosed with GCA by random temporal artery biopsy.

Keyword

Giant cell arteritis; Fever of unknown origin; Positron emission tomography

MeSH Terms

Biopsy
Fever
Fever of Unknown Origin
Giant Cell Arteritis
Giant Cells
Headache
Humans
Jaw
Korea
Positron-Emission Tomography
Systemic Vasculitis
Temporal Arteries

Figure

• 

  Figure 1 18F-fluorodeoxyglucose positron emission tomography showed uptake along the aorta wall and common carotid, brachiocephalic and subclavian arteries with a mild but suspicious wall thickening.

• 

  Figure 2 Granulomatous, multinucleated giant cell (arrow) and chronic inflammatory (lymphocytes and plasma cells) cell infiltration were observed in the adventitia and medial wall of the temporal artery (H&E stain ×100).

Reference

1. Chew SS, Kerr NM, Danesh-Meyer HV. Giant cell arteritis. J Clin Neurosci. 2009. 16:1263–1268.

2. Chang HK, Hur SH, Chung HR. A case of giant cell arteritis developed in polymyalgia rheumatica. J Korean Rheum Assoc. 2000. 7:72–76.

3. Seo JW, Hur J, Kim HO, Jeon DH, Baek JH, Kim JH, et al. A case of atypical giant cell arteritis presenting as Raynaud's phenomenon and diagnosed by random temporal artery biopsy. J Korean Rheum Assoc. 2010. 17:278–282.

4. Arnaud L, Haroche J, Malek Z, Archambaud F, Gambotti L, Grimon G, et al. Is (18)F-fluorodeoxyglucose positron emission tomography scanning a reliable way to assess disease activity in Takayasu arteritis? Arthritis Rheum. 2009. 60:1193–1200.

5. Breuer GS, Nesher G, Nesher R. Rate of discordant findings in bilateral temporal artery biopsy to diagnose giant cell arteritis. J Rheumatol. 2009. 36:794–796.

6. Czihal M, Tatò F, Förster S, Rademacher A, Schulze-Koops H, Hoffmann U. Fever of unknown origin as initial manifestation of large vessel giant cell arteritis: diagnosis by colour-coded sonography and 18-FDG-PET. Clin Exp Rheumatol. 2010. 28:549–552.

7. Direskeneli H, Aydin SZ, Merkel PA. Assessment of disease activity and progression in Takayasu's arteritis. Clin Exp Rheumatol. 2011. 29:1 Suppl 64. S86–S91.

8. Wang X, Hu ZP, Lu W, Tang XQ, Yang HP, Zeng LW, et al. Giant cell arteritis. Rheumatol Int. 2008. 29:1–7.

9. Cantini F, Niccoli L, Nannini C, Bertoni M, Salvarani C. Diagnosis and treatment of giant cell arteritis. Drugs Aging. 2008. 25:281–297.

10. Nesher G, Berkun Y, Mates M, Baras M, Rubinow A, Sonnenblick M. Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis. Arthritis Rheum. 2004. 50:1332–1337.