McCausland Beth, Desai David, Havard David, Kaur Yasmin, Yener Asalet, Bradley Emma, Patel Harnish P
Medicine for Older People, University Hospital Southampton, Southampton SO16 6YD, UK.
Academic Geriatric Medicine, University of Southampton, University Hospital, Southampton SO16 6YD, UK.
Geriatrics (Basel). 2018 Jun 29;3(3):36. doi: 10.3390/geriatrics3030036.
Giant cell arteritis/temporal arteritis (GCA) is an inflammatory condition that affects large to medium vessels such as the aorta and its primary branches. Patients classically present with fatigue, fever, headache, jaw claudication and in severe cases, may suffer either transient (amaurosis fugax) or permanent visual loss. The reference standard for diagnosis is the temporal artery biopsy (TAB) and the mainstay of treatment is with immunosuppression. Our patient JG, presented with a range of non-specific symptoms that mimicked generalised sepsis, but was ultimately diagnosed with GCA through effective, methodical multi-disciplinary team (MDT) work. JG, an 81 year old gentleman, presented acutely with a 3-4 weeks history of fatigue, lethargy, pyrexia and a marked inflammatory response suggestive of a sepsis but without a clear primary source or clinical features of vasculitis. His inflammatory markers were markedly raised although his erythrocyte sedimentation rate (ESR) was not elevated. He was initially treated for sepsis of unknown origin however, body imaging after admission suggested a possible infection around a previous aortic graft site. This was refuted in subsequent 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET/CT) scanning. Microbiological, parasitic, as well as autoimmune assays were unremarkable. He underwent a TAB which was diagnostic for GCA and as a result, was started on oral corticosteroids with immediate symptom relief. He was discharged and followed up on an outpatient basis. This case highlights how a vasculitis can present with a range of non-specific symptoms that may resemble a fever of unknown origin (FUO)/sepsis that can lead to a delay in making the correct diagnosis. It also highlights the importance of considering a diagnosis of vasculitis in patients who present with a FUO where there is no clear focus of infection. Delays in diagnosis and management of these conditions can potentially lead to significant irreversible morbidity.
巨细胞动脉炎/颞动脉炎(GCA)是一种炎症性疾病,可影响大到中等大小的血管,如主动脉及其主要分支。典型的患者表现为疲劳、发热、头痛、颌部间歇性运动障碍,严重时可能会出现短暂性(一过性黑矇)或永久性视力丧失。诊断的参考标准是颞动脉活检(TAB),治疗的主要方法是免疫抑制。我们的患者JG出现了一系列非特异性症状,类似于全身性脓毒症,但最终通过有效的、有条不紊的多学科团队(MDT)协作被诊断为GCA。JG是一位81岁的男性,急性起病,有3 - 4周的疲劳、嗜睡、发热病史,以及明显的炎症反应,提示脓毒症,但没有明确的原发灶或血管炎的临床特征。他的炎症标志物显著升高,尽管红细胞沉降率(ESR)未升高。他最初因不明原因的脓毒症接受治疗,然而入院后的身体成像显示先前主动脉移植部位周围可能存在感染。随后的18F - 氟脱氧葡萄糖 - 正电子发射断层扫描(FDG - PET/CT)排除了这一可能。微生物学、寄生虫学以及自身免疫检测均无异常。他接受了颞动脉活检,结果确诊为GCA,因此开始口服皮质类固醇,症状立即缓解。他出院后接受门诊随访。该病例突出了血管炎如何表现出一系列非特异性症状,这些症状可能类似于不明原因发热(FUO)/脓毒症,从而导致正确诊断的延迟。它还强调了在出现不明原因发热且无明确感染灶的患者中考虑血管炎诊断的重要性。这些疾病诊断和管理的延迟可能会导致严重的不可逆的发病率。