Delayed Diagnosis of Biopsy-Negative Giant Cell Arteritis Presenting as Fever of Unknown Origin

Schäfer, Valentin Sebastian; Warrington, Kenneth J.; Williamson, Eric E.; Kermani, Tanaz A.

doi:10.1007/s11606-009-0925-9

Cited by 17 publications

(8 citation statements)

References 13 publications

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“…In suspected temporal arteritis, the diagnostic role of FDG PET/CT is limited and is recommended that temporal artery biopsy performed prior to further evaluation of the FUO by PET/CT . However, FDG PET/CT may demonstrate inflammatory changes in larger arteries sized >4 mm during various other inflammatory processes of blood vessels .…”

Section: Methodsmentioning

confidence: 99%

The diagnostic role of ¹⁸F fluorodeoxyglucose positron emission tomography in patients with fever of unknown origin

Sioka

Assimakopoulos

Fotopoulos

2015

Eur J Clin Investigation

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Background Identification of aetiology for fever of unknown origin (FUO) is challenging, due to the high rates of undiagnosed cases. The current diagnostic approach includes initially first-line procedures such as general examination and various laboratory tests and basic imaging techniques followed by second-line tests such as more advanced imaging techniques including 18 F fluorodeoxyglucose positron emission tomography (FDG PET) and tissue biopsies. If no diagnosis is obtained, more invasive measures may be in order such as liver biopsy and exploratory laparotomy.

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Section: Methodsmentioning

confidence: 99%

The diagnostic role of ¹⁸F fluorodeoxyglucose positron emission tomography in patients with fever of unknown origin

Sioka

Assimakopoulos

Fotopoulos

2015

Eur J Clin Investigation

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“…This has been reinforced by numerous case reports describing the use of 18F-FDG PET scanning to diagnose GCA. [63][64][65] PET scanning, in comparison to MRI, has shown comparable sensitivities in diagnosing. However, PET scanning allows simultaneous identification of more affected vessels than MRI.…”

Section: Use Of Combined Pet-ct In Lvvmentioning

confidence: 99%

Current Controversies in Large-Vessel Inflammatory Vasculitis and Thoracic Aortic Aneurysm Disease

et al. 2019

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Large-vessel vasculitis encompasses the spectrum of vasculitides, which pathologically cause chronic granulomatous inflammatory changes, primarily in the aorta and its major branches. These patients are at risk of developing life-threatening aortic lesions that, without recognition and prompt treatment, can cause detrimental effects. Many provocative issues surrounding large-vessel vasculitis and its surgical treatment still remain, spanning from recognition to management. In this review, we discuss the main large-vessel vasculitides, Takayasu's arteritis and giant cell arteritis. We include the key points and current controversies surrounding diagnostic imaging, timing of interventions, and patient outcomes.

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“…In three patients with vasculitis, Otsuka et al using PET/CT scan demonstrated an increase of FDG-uptake along the aorta and carotid artery; after steroid therapy a normalization of FDG-uptake in the respective vessels was observed [3]. FDG scan detects the early stage of GCA, and identifies the extent of the sites of inflammation of medium and large vessels [4][5][6]. In patients with fever of unknown origin, FDG scan can also show signs of vasculitis [7].…”

mentioning

confidence: 99%

[18F]-FDG PET/CT Scan Detected Giant Cell Arteritis After Negative Temporal Artery Biopsy

Medina-Quiroz¹,

Martínez-Rodríguez²,

Banzo³

et al. 2011

TONMEDJ

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Giant Cell Arteritis is frequently associated to polymyalgia rheumatica. A 65-years old female patient with a 1-year history of polymyalgia rheumatica was admitted with clinical symptoms and laboratory data of a subacute inflammatory process. Cranial and whole-body CT scans were normal. A [18F]-FDG PET/CT scan showed an extensive increased uptake in the walls of the thoracic and abdominal aorta and also in the common carotid, subclavian and axillary arteries. Biopsy of temporal artery confirmed the diagnosis of giant cell arteritis.Keywords: FDG PET/CT, giant cell arteritis, polymyalgia rheumatica, vasculitis.A 65 years-old woman with a one year history of polymyalgia rheumatica under corticosteroid treatment complained of nocturnal headache and jaw claudication. Physical examination revealed pain to palpation of the right temporal artery with a decreased pulse. Laboratory tests showed a high erythrocyte sedimentation rate (ESR) and elevated C-reactive protein (CRP). Whole-body and cranial contrast CT scans were normal. Right temporal arterial biopsy was reported as myointimal fibrosis without evidence of arteritis. The dose of corticosteroids was increased and the patient was discharged without symptoms.Three months later the patient developed fatigue, weakness, weight loss, headache, jaw claudication and low grade fever, in coincidence with the decreasing regimen of corticosteroids. Physical examination revealed the absence of pulse of the left temporal artery. ESR, CRP and protein electrophoresis showed a pattern of subacute inflammation. Tumor markers and sputum culture were normal. For differential diagnosis, vasculitis, infection and tumor of unknown origin had to be considered.The patient underwent a [18F]-FDG PET/CT (FDG) scan. Forty-eight hours before exam the patient was on a low carbohydrate diet and fasted the 6 previous hours. Basal glucose serum level was 90 mg/dl. The study was acquired 90 min after intravenous injection of 444 MBq [18F]-FDG with BIOGRAPH LSO pico 3D Siemens equipment. First, a low-dose CT scan was acquired. No oral or intravenous contrast were used. CT acquisition parameters were: 130 kV, 50 mA, slice thickness 5 mm, rotation of the detector 800 ms and scan speed of the table 8 mm per rotation. CT data were used for attenuation correction and anatomical localization purposes. Following CT scan, PET scan was acquired from the base of the skull to the root of the thighs (6 beds, 2 min

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Delayed Diagnosis of Biopsy-Negative Giant Cell Arteritis Presenting as Fever of Unknown Origin

Cited by 17 publications

References 13 publications

The diagnostic role of ¹⁸F fluorodeoxyglucose positron emission tomography in patients with fever of unknown origin

The diagnostic role of ¹⁸F fluorodeoxyglucose positron emission tomography in patients with fever of unknown origin

Current Controversies in Large-Vessel Inflammatory Vasculitis and Thoracic Aortic Aneurysm Disease

[18F]-FDG PET/CT Scan Detected Giant Cell Arteritis After Negative Temporal Artery Biopsy

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Delayed Diagnosis of Biopsy-Negative Giant Cell Arteritis Presenting as Fever of Unknown Origin

Cited by 17 publications

References 13 publications

The diagnostic role of 18F fluorodeoxyglucose positron emission tomography in patients with fever of unknown origin

The diagnostic role of 18F fluorodeoxyglucose positron emission tomography in patients with fever of unknown origin

Current Controversies in Large-Vessel Inflammatory Vasculitis and Thoracic Aortic Aneurysm Disease

[18F]-FDG PET/CT Scan Detected Giant Cell Arteritis After Negative Temporal Artery Biopsy

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The diagnostic role of ¹⁸F fluorodeoxyglucose positron emission tomography in patients with fever of unknown origin

The diagnostic role of ¹⁸F fluorodeoxyglucose positron emission tomography in patients with fever of unknown origin