F Tatò1, M Weiss, U Hoffmann. 1. Klinikum der Ludwig-Maximilians Universität, Medizinische Poliklinik, Gefässzentrum Innenstadt -- Angiologie, München. federico.tato@med.uni-muenchen.de
Abstract
HISTORY AND CLINICAL FINDINGS: Two women, aged 59 and 53 years, presented with a history of several months of classical fever of unknown origin (FUO), largely normal physical findings, and elevated markers of systemic inflammation. INVESTIGATIONS: After initially unremarkable findings, duplex-sonography detected circular, hypoechogenic wall thickening of the axillary arteries without hemodynamically significant narrowing of the lumen. 18F-fluorodeoxyglucose positrone emission-tomography (18F-FDG-PET) revealed marked vascular tracer uptake in the aorta and in the proximal arteries of the arms and legs. TREATMENT AND FOLLOW-UP: The diagnosis of Takayasu's arteritis was made, and high-dose prednisone treatment was initiated. Within a few days both patients became asymptomatic. CONCLUSIONS: Large vessel vasculitis is a known cause of FUO. Duplex-sonography and 18F-FDG-PET are able to detect these disorders at an early stage before the onset of clinically relevant arterial obstructions. More widespread use of these techniques may show that large-vessel vasculitis is more common than previously thought.
HISTORY AND CLINICAL FINDINGS: Two women, aged 59 and 53 years, presented with a history of several months of classical fever of unknown origin (FUO), largely normal physical findings, and elevated markers of systemic inflammation. INVESTIGATIONS: After initially unremarkable findings, duplex-sonography detected circular, hypoechogenic wall thickening of the axillary arteries without hemodynamically significant narrowing of the lumen. 18F-fluorodeoxyglucose positrone emission-tomography (18F-FDG-PET) revealed marked vascular tracer uptake in the aorta and in the proximal arteries of the arms and legs. TREATMENT AND FOLLOW-UP: The diagnosis of Takayasu's arteritis was made, and high-dose prednisone treatment was initiated. Within a few days both patients became asymptomatic. CONCLUSIONS: Large vessel vasculitis is a known cause of FUO. Duplex-sonography and 18F-FDG-PET are able to detect these disorders at an early stage before the onset of clinically relevant arterial obstructions. More widespread use of these techniques may show that large-vessel vasculitis is more common than previously thought.