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Case Reports: Unusual presentation of more common disease/injury
Atypical giant cell arteritis presentations diagnosed with FDG-18 whole body PET imaging
  1. Nimal Vijayaraghavan1,
  2. Jaye Martin2,
  3. Waranga Jayawickrama1 and
  4. Ohide Otome3,4
  1. 1 Department of General Medicine, Rockingham General Hospital, Cooloongup, Western Australia, Australia
  2. 2 Department of General Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  3. 3 Department of General Medicine, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
  4. 4 Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Dr Nimal Vijayaraghavan; nimalv19{at}gmail.com

Abstract

Two male patients aged above 70 years were investigated for chronic non-specific symptoms and evidence of significant systemic inflammation, but without classic ‘cranial symptoms’ of giant cell arteritis (GCA). Each patient had multiple non-diagnostic investigations, but finally extensive large-vessel vasculitis was revealed by whole body positron emission tomography/CT imaging. Both cases were confirmed to have GCA on temporal artery biopsy and responded well to initial high-dose prednisolone therapy. The patients successfully completed 12 months of steroid-sparing therapy with tocilizumab and achieved remission of their condition.

  • Immunology
  • Geriatric medicine
  • General practice / family medicine
  • Vasculitis
  • Medical education

http://dx.doi.org/10.1136/bcr-2022-251406

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    Footnotes

    • Contributors All authors (NV, OO, JM and WJ) were involved in the conceptualisation and design of the article. Tables and images (exempting the PET images) were created by NV. Authors, OO, NV and WJ were personally involved in the management of one or both cases. Clinical information on the cases were obtained through patient hospital records and analysed thoroughly by all four authors. Additional information on the presentation and management of the cases were obtained via personal interviews with the patients conducted by WJ, OO and NV. This article was extensively reviewed and formatted by all four authors before unanimous approval of the final manuscript draft was achieved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.