Shibata Tomohiko, Shibata Toshiko, Ozaki Shoichi, Ichikawa Yoichi, Itoh Gen
Division of Rheumatology and Allergy Department of Internal Medicine, St. Marianna University School of Medicine.
Nihon Rinsho Meneki Gakkai Kaishi. 2009 Apr;32(2):129-34. doi: 10.2177/jsci.32.129.
The patient was a 74-year-old female presenting with abrupt onset of fever and proximal muscle pains. She had been diagnosed with polymyalgia rheumatica (PMR). On physical examination, there was no tenderness or dilatation of the temporal artery and ocular fundi were normal. 18F-FDG-PET revealed accumulation of FDG in the aorta as well as in the bilateral subclavian arteries, which strongly suggested inflammation of the large blood vessels. Magnetic resonance angiography disclosed stenosis of the bilateral subclavian arteries, which was consistent with angitis. This case was considered to have developed PMR at an old age with positive HLA DR4, and to have a complication large-vessel giant cell arteritis (LV-GCA). Administration of prednisolone at a dose of 20 mg/day promptly relieved the fever and the myalgia as well. It is difficult to diagnose GCA in PMR if no tenderness or dilatation of the temporal artery is present. FDG-PET is considered useful, not only for exploration of tumors, but also for evaluation of inflammation of large vessels.
患者为一名74岁女性，突发发热和近端肌肉疼痛。她被诊断为风湿性多肌痛（PMR）。体格检查时，颞动脉无压痛或扩张，眼底正常。18F-FDG-PET显示主动脉以及双侧锁骨下动脉有FDG积聚，强烈提示大血管炎症。磁共振血管造影显示双侧锁骨下动脉狭窄，这与血管炎相符。该病例被认为是老年时发生的PMR，HLA DR4阳性，并伴有大血管巨细胞动脉炎（LV-GCA）并发症。每天服用20毫克泼尼松龙可迅速缓解发热和肌痛。如果颞动脉无压痛或扩张，则很难在PMR中诊断出GCA。FDG-PET不仅被认为对肿瘤探查有用，而且对大血管炎症的评估也有用。
