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Kang, Park, Jeon, Kang, Lee, Lee, and Park: A Case of Atypical Giant Cell Arteritis Presenting as a Fever of Unknown Origin
Case Report
Journal of Rheumatic Diseases

Journal of Rheumatic Diseases 2012; 19(5): 299-301.

Published online: 31 October 2012

DOI: https://doi.org/10.4078/jrd.2012.19.5.299

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

Mi Il Kang1, Hee Jin Park1, Hyae Min Jeon2, Yoon Kang1, Sang Won Lee1, Soo-Kon Lee1, Yong-Beom Park1

1Department of Internal Medicine, Yonsei University College of Medicine, Institute for Immunology and Immunologic Disease, Seoul, Korea.

2Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.

Corresponding to: Yong-Beom Park, Department of Internal Medicine, Yonsei University College of Medicine, Institute for Immunology and Immunologic Disease, Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea. yongbpark@yuhs.ac

Received 2 November 2011       Revised 28 November 2011       Accepted 28 November 2011

Copyright © 2012 by The Korean College of Rheumatology

(free-access):

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Giant cell arteritis, Fever of unknown origin, Positron emission tomography

Figures and Tables

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.
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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).
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