Positron emission tomography and reframing vasculitis as a spectrum of disease when investigating a patient with a fever of unknown origin. (19th September 2018)

• Record Type: Journal Article
• Authors: Shahi, Farah; Samson, Anda
• Is Part Of: BMJ case reports. Volume 2018
• Publication Date: 2018-09-19
• Subjects: infectious diseases -- vasculitis -- musculoskeletal syndromes -- radiology; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2018-224540
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A retired businessman presented to the infectious diseases department with a history of ongoing fevers and myalgia and raised inflammatory markers. This continued despite adequate antibiotic treatment of an epididymo-orchitis. Extensive investigations, including bone marrow and liver biopsies and a positron emission tomography, did not reveal a cause but showed reactive change in the bone marrow. Later, he developed a vasculitic rash and vision loss due to non-arteritic anterior ischaemic optic neuropathy. High-dose steroids were immediately initiated. A temporal artery biopsy was performed, which confirmed a healing large vessel vasculitis, possibly giant cell arteritis. He has responded very well to therapy. We must better appreciate the limitations of positron emission tomography in investigating a fever of unknown origin. The case also encourages awareness of autoimmune disorders as the leading category of causative diseases for this in older age groups.