title: Delayed diagnosis of biopsy-negative giant cell arteritis presenting as fever of unknown origin.
abstract: Fever of unknown origin (FUO) presents a diagnostic challenge. Giant cell arteritis (GCA) may present with FUO and this entity should be included in the differential of elderly patients who present with constitutional symptoms. While a temporal artery biopsy is considered the gold standard for the diagnosis of GCA, a subset of patients with large vessel involvement by GCA may have a negative temporal artery biopsy and no cranial symptoms. We present a 79 year-old woman with FUO and negative temporal artery biopsies in whom diagnosis of GCA was delayed. Further imaging with CT-angiogram and positron emission tomography/computed tomography (PET/CT) scan showed diffuse extensive active vasculitis. The above case underscores the value of imaging studies in the evaluation of patients with FUO from occult large vessel vasculitis.
authors.affiliation: Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Valentin S
authors.initials: VS
authors.lastname: Schäfer
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Warrington
authors.forename: Eric E
authors.initials: EE
authors.lastname: Williamson
authors.forename: Tanaz A
authors.initials: TA
authors.lastname: Kermani
mesh_terms: D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis*; D013700:Giant Cell Arteritis / Q000175:diagnosis*; D006801:Humans; D049268:Positron-Emission Tomography; D013699:Temporal Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed