title: Migratory large vessel vasculitis preceding acute myeloid leukemia: a case report.
abstract: BACKGROUND
  Large vessel vasculitis is a rare disorder usually occurring in the context of the autoimmune conditions of giant cell arteritis and Takayasu's arteritis. Case reports have described large vessel vasculitis occurring in individuals with myelodysplastic syndrome, preceding transformation to acute myeloid leukemia.
  
  
  METHODS
  A 56-year-old Afghanistan-born woman presented with fever, a tender left carotid artery, and raised inflammatory markers. Computed tomography revealed thickening of the wall of her left carotid artery. Her symptoms resolved spontaneously; however, they recurred weeks later on the contralateral side, along with abdominal pain after eating. Further imaging with computed tomography and positron emission tomography demonstrated resolution of her left carotid artery abnormality, but new wall thickening and inflammation in her right carotid artery, abdominal aorta, and superior mesenteric artery. She was diagnosed as having large vessel vasculitis, which resolved with corticosteroids and methotrexate. Five months later, she developed acute myeloid leukemia. She had no known history of myelodysplastic syndrome at the time of diagnosis with vasculitis.
  
  
  CONCLUSIONS
  Large vessel vasculitis in older individuals presenting with atypical clinical features, such as a migratory pattern of affected vessels, vessel wall tenderness, and marked systemic inflammation, should prompt a search for underlying myelodysplasia. Clinicians should be vigilant for progression to acute myeloid leukemia.
authors.affiliation: Department of Immunopathology, Pathology West, ICPMR, Westmead Hospital, Sydney, 2145, NSW, Australia. cdinusha@gmail.com.|Faculty of Medicine, University of Sydney, Sydney, NSW, 2000, Australia. cdinusha@gmail.com.
authors.forename: Dinusha
authors.identifier: http://orcid.org/0000-0001-9833-3003
authors.initials: D
authors.lastname: Chandratilleke
authors.affiliation: Department of Immunopathology, Pathology West, ICPMR, Westmead Hospital, Sydney, 2145, NSW, Australia.
authors.forename: Anthea
authors.initials: A
authors.lastname: Anantharajah
authors.affiliation: Department of Vascular Surgery, Westmead Hospital, Sydney, 2145, NSW, Australia.
authors.forename: Mauro
authors.initials: M
authors.lastname: Vicaretti
authors.affiliation: Department of Haematology, Westmead Hospital, Sydney, 2145, NSW, Australia.
authors.forename: Warwick
authors.initials: W
authors.lastname: Benson
authors.affiliation: Department of Immunopathology, Pathology West, ICPMR, Westmead Hospital, Sydney, 2145, NSW, Australia.|Faculty of Medicine, University of Sydney, Sydney, NSW, 2000, Australia.
authors.forename: Lucinda J
authors.initials: LJ
authors.lastname: Berglund
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis / Q000209:etiology; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D049268:Positron-Emission Tomography; D013625:Takayasu Arteritis / Q000000981:diagnostic imaging* / Q000473:pathology; D014055:Tomography, Emission-Computed; D014657:Vasculitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy
chemical_list: D000970:Antineoplastic Agents; D019788:Fluorodeoxyglucose F18
keywords: AML; Acute myeloid leukemia; Autoimmune; Large vessel; MDS; Migratory; Myelodysplasia; Vasculitis