title: Fever of unknown origin as initial manifestation of large vessel giant cell arteritis: diagnosis by colour-coded sonography and 18-FDG-PET.
abstract: OBJECTIVE
  To evaluate the clinical characteristics and imaging results (CDS, 18-FDG-PET) of patients with large vessel giant cell arteritis (LV-GCA) presenting as fever of unknown origin (FUO).
  
  
  METHODS
  From a series of 82 patients with GCA we identified 8 patients with FUO as initial disease manifestation. Clinical characteristics and results of CDS and 18-FDG-PET were analysed. Patients with FUO and those with other clinical manifestations of GCA were compared.
  
  
  RESULTS
  18-FDG-PET-scans were available for 6/8 patients, revealing enhanced tracer uptake of the thoracic aorta and the aortic branches in all patients. CDS was performed in 8/8 patients, with detection of hypoechogenic wall thickening related to LV-GCA in 7/8 patients. Subjects with FUO were significantly younger (60.9 vs. 69.3 years, p<0.01) and had a stronger humoral inflammatory response (CRP 12.6 vs. 7.1 mg/dl, p<0.01; ESR 110 vs. 71 mm/hour, p<0.01), when compared to the other GCA-patients.
  
  
  CONCLUSIONS
  LV-GCA should be considered as important differential diagnosis in patients with FUO. In addition to 18-FDG-PET, which is known to be a valuable method in the diagnostic work-up of FUO, we recommend CDS of the supraaortal and femoropopliteal arteries for the initial diagnostic work-up.
authors.affiliation: Division of Vascular Medicine, Campus City Center, University Hospital Munich, Germany. michael.czihal@med.uni-muenchen.de
authors.forename: M
authors.initials: M
authors.lastname: Czihal
authors.forename: F
authors.initials: F
authors.lastname: Tatò
authors.forename: S
authors.initials: S
authors.lastname: Förster
authors.forename: A
authors.initials: A
authors.lastname: Rademacher
authors.forename: H
authors.initials: H
authors.lastname: Schulze-Koops
authors.forename: U
authors.initials: U
authors.lastname: Hoffmann
mesh_terms: D000367:Age Factors; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D019788:Fluorodeoxyglucose F18; D013700:Giant Cell Arteritis / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D019788:Fluorodeoxyglucose F18