Giant Cell Arteritis Exclusively Detected by 18F-fluorodeoxyglucose Positron Emission Tomography: a Case Report

Overview

Journal J Med Case Rep

Publisher Biomed Central

Specialty General Medicine

Date 2014 Oct 29

PMID 25348576

Authors

Markus Bruckner

Dominik Bettenworth

Karin Hengst

Matthias Weckesser

Peter Willeke

Jan Heidemann

Affiliations

Soon will be listed here.

Abstract

Introduction: This case of giant cell arteritis is noteworthy because it evaded standard diagnostic criteria and only emerged as fever of unknown origin. In this regard, we present 18F-fluorodeoxyglucose positron emission tomography as a valid diagnostic method.

Case Presentation: This case report describes a 58-year-old Caucasian woman who is a cigarette smoker with a 10-week history of fever of unknown origin, night sweats and weight loss of 12 kg. Initially, clinical presentation was suspicious of malignant disease. Laboratory findings detected significantly elevated inflammatory blood parameters including C-reactive protein and elevated erythrocyte sedimentation rate (110 mm/hour). Extensive diagnostic workup including microbiological and rheumatological assessment, ultrasonography, endoscopy and computed tomography of abdomen and thorax did not indicate any septic or malignant focus. Eventually, 18F-fluorodeoxyglucose positron emission tomography was able to reveal arteritis of her aortic arch and supraaortic branches. Subsequently, she commenced steroid and methotrexate therapy that led to sustained remission.

Conclusions: This case of giant cell arteritis may promote discussion regarding a more specific classification for this disease entity. Furthermore, it confirms that 18F-fluorodeoxyglucose positron emission tomography might serve as a valuable tool for diagnosis of giant cell arteritis, because it could facilitate an accurate and non-invasive detection of lesions of large vessels.

References

Mourad O, Palda V, Detsky A . A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med. 2003; 163(5):545-51. DOI: 10.1001/archinte.163.5.545. View

Tso E, Flamm S, White R, Schvartzman P, Mascha E, Hoffman G . Takayasu arteritis: utility and limitations of magnetic resonance imaging in diagnosis and treatment. Arthritis Rheum. 2002; 46(6):1634-42. DOI: 10.1002/art.10251. View

Penn H, Dasgupta B . Giant cell arteritis. Autoimmun Rev. 2003; 2(4):199-203. DOI: 10.1016/s1568-9972(03)00012-0. View

Calamia K, Hunder G . Giant cell arteritis (temporal arteritis) presenting as fever of undetermined origin. Arthritis Rheum. 1981; 24(11):1414-8. DOI: 10.1002/art.1780241113. View

Knockaert D, Vanderschueren S, Blockmans D . Fever of unknown origin in adults: 40 years on. J Intern Med. 2003; 253(3):263-75. DOI: 10.1046/j.1365-2796.2003.01120.x. View

Schattner A, Klepfish A . Left pleural effusion and fever of unknown origin--a clue to thoracic arterial pathology. J Gen Intern Med. 2012; 27(8):1084-7. PMC: 3403133. DOI: 10.1007/s11606-012-2008-6. View

de Kleijn E, Vandenbroucke J, van der Meer J . Fever of unknown origin (FUO). I A. prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. The Netherlands FUO Study Group. Medicine (Baltimore). 1997; 76(6):392-400. DOI: 10.1097/00005792-199711000-00002. View

Lee S, Ryu J, Kim H, Oh J, Kim Y, Lee C . Evaluation of disease activity using F-18 FDG PET-CT in patients with Takayasu arteritis. Clin Nucl Med. 2009; 34(11):749-52. DOI: 10.1097/RLU.0b013e3181b7db09. View

Weyand C, Goronzy J . Giant-cell arteritis and polymyalgia rheumatica. Ann Intern Med. 2003; 139(6):505-15. DOI: 10.7326/0003-4819-139-6-200309160-00015. View

10.

Weyand C, Tetzlaff N, Bjornsson J, Brack A, Younge B, Goronzy J . Disease patterns and tissue cytokine profiles in giant cell arteritis. Arthritis Rheum. 1997; 40(1):19-26. DOI: 10.1002/art.1780400105. View

11.

Hunder G, Bloch D, Michel B, STEVENS M, Arend W, Calabrese L . The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990; 33(8):1122-8. DOI: 10.1002/art.1780330810. View

12.

Vanderschueren S, Knockaert D, Adriaenssens T, Demey W, Durnez A, Blockmans D . From prolonged febrile illness to fever of unknown origin: the challenge continues. Arch Intern Med. 2003; 163(9):1033-41. DOI: 10.1001/archinte.163.9.1033. View

13.

Balink H, Collins J, Bruyn G, Bruyn G, Gemmel F . F-18 FDG PET/CT in the diagnosis of fever of unknown origin. Clin Nucl Med. 2010; 34(12):862-8. DOI: 10.1097/RLU.0b013e3181becfb1. View

14.

Ness T, Bley T, Schmidt W, Lamprecht P . The diagnosis and treatment of giant cell arteritis. Dtsch Arztebl Int. 2013; 110(21):376-85. PMC: 3679627. DOI: 10.3238/arztebl.2013.0376. View

15.

Brodmann M, Lipp R, Passath A, Seinost G, Pabst E, Pilger E . The role of 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography in the diagnosis of giant cell arteritis of the temporal arteries. Rheumatology (Oxford). 2003; 43(2):241-2. DOI: 10.1093/rheumatology/keh025. View

16.

Walter M, Melzer R, Schindler C, Muller-Brand J, Tyndall A, Nitzsche E . The value of [18F]FDG-PET in the diagnosis of large-vessel vasculitis and the assessment of activity and extent of disease. Eur J Nucl Med Mol Imaging. 2005; 32(6):674-81. DOI: 10.1007/s00259-004-1757-9. View

17.

Salvarani C, Cantini F, Hunder G . Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008; 372(9634):234-45. DOI: 10.1016/S0140-6736(08)61077-6. View

18.

Meller J, Altenvoerde G, Munzel U, Jauho A, Behe M, Gratz S . Fever of unknown origin: prospective comparison of [18F]FDG imaging with a double-head coincidence camera and gallium-67 citrate SPET. Eur J Nucl Med. 2000; 27(11):1617-25. DOI: 10.1007/s002590000341. View

19.

Weyand C, Goronzy J . Medium- and large-vessel vasculitis. N Engl J Med. 2003; 349(2):160-9. DOI: 10.1056/NEJMra022694. View

20.

Bleeker-Rovers C, Vos F, de Kleijn E, Mudde A, Dofferhoff T, Richter C . A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic protocol. Medicine (Baltimore). 2007; 86(1):26-38. DOI: 10.1097/MD.0b013e31802fe858. View