Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Kispaticeva 12, Zagreb, Croatia.
Rheumatol Int. 2013 Sep;33(9):2417-21. doi: 10.1007/s00296-012-2425-1. Epub 2012 Mar 28.
PET/CT is starting to play an important role in evaluating fever of unknown origin (FUO), due to its ability to localize and delineate areas of high metabolic activity, such as neoplastic proliferation and inflammation, including vasculitis. We present a case of giant cell arteritis (GCA) in a 72-year-old female patient admitted to our department with a 4-month history of FUO, weight loss and fatigue, without specific symptoms or signs. Laboratory investigations suggested acute phase response, with a pronounced erythrocyte sedimentation rate, high CRP level and microcytic anemia. A thorough diagnostic evaluation was performed to exclude an unknown primary tumor, which was initially suspected due to a positive family history of cancer. Surprisingly, PET/CT revealed large vessel vasculitis affecting the ascending, descending and abdominal aorta, as well as subclavian, proximal brachial and carotid arteries bilaterally. Biopsy of the superficial temporal artery confirmed the diagnosis of GCA. Treatment with methylprednisolone and azathioprine led to resolution of clinical symptoms and normalization of laboratory parameters. In addition to the use of PET/CT in the evaluation of FUO, its value as a method complementary to temporal artery biopsy is also discussed.
PET/CT 在评估不明原因发热（FUO）方面开始发挥重要作用，因为它能够定位和描绘高代谢活动区域，如肿瘤增殖和炎症，包括血管炎。我们报告了一例 72 岁女性患者的巨细胞动脉炎（GCA）病例，该患者因 FUO、体重减轻和疲劳而入院，无特定症状或体征。实验室检查提示急性期反应，红细胞沉降率、CRP 水平升高和小细胞性贫血明显。进行了彻底的诊断评估以排除未知原发性肿瘤，最初由于癌症的阳性家族史而怀疑该肿瘤。令人惊讶的是，PET/CT 显示大血管血管炎累及升主动脉、降主动脉和腹主动脉，以及双侧锁骨下动脉、近端肱动脉和颈动脉。颞动脉活检证实了 GCA 的诊断。用甲基强的松龙和硫唑嘌呤治疗后，临床症状得到缓解，实验室参数恢复正常。除了在 FUO 的评估中使用 PET/CT 外，还讨论了其作为颞动脉活检补充方法的价值。
