Schäfer Valentin S, Warrington Kenneth J, Williamson Eric E, Kermani Tanaz A
Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
J Gen Intern Med. 2009 Apr;24(4):532-6. doi: 10.1007/s11606-009-0925-9. Epub 2009 Feb 18.
Fever of unknown origin (FUO) presents a diagnostic challenge. Giant cell arteritis (GCA) may present with FUO and this entity should be included in the differential of elderly patients who present with constitutional symptoms. While a temporal artery biopsy is considered the gold standard for the diagnosis of GCA, a subset of patients with large vessel involvement by GCA may have a negative temporal artery biopsy and no cranial symptoms. We present a 79 year-old woman with FUO and negative temporal artery biopsies in whom diagnosis of GCA was delayed. Further imaging with CT-angiogram and positron emission tomography/computed tomography (PET/CT) scan showed diffuse extensive active vasculitis. The above case underscores the value of imaging studies in the evaluation of patients with FUO from occult large vessel vasculitis.
不明原因发热（FUO）是一个诊断难题。巨细胞动脉炎（GCA）可能表现为不明原因发热，对于出现全身症状的老年患者，鉴别诊断时应考虑到这一疾病。虽然颞动脉活检被认为是诊断GCA的金标准，但一部分GCA累及大血管的患者颞动脉活检可能为阴性且无颅脑症状。我们报告一例79岁不明原因发热且颞动脉活检阴性的女性患者，其GCA诊断被延迟。进一步的CT血管造影和正电子发射断层扫描/计算机断层扫描（PET/CT）显示弥漫性广泛活动性血管炎。上述病例强调了影像学检查在评估隐匿性大血管血管炎所致不明原因发热患者中的价值。
