A case of Takayasu’s Arteritis Presented with Fever of Unknown Origin: Diagnostic Value of 18F-FDG PET/CT Imaging

Takayasu’s arteritis is a chronic vasculitis of the large vessels and has a rare initial presentation of fever of unknown origin (FUO), renders the condition difficult to diagnose. Fluorodeoxyglucose (FDG) positron-emission tomography-computed tomography (PET-CT) can assist in the early diagnosis of Takayasu’s Arteritis patients with FUO and can improve the prognosis of such patients. In this case report, we describe a 27-year-old female presented with one-month history of FUO, showing heterogeneous increased FDG accumulation along the walls of ascending and arch of aorta, left subclavian artery and right brachiocephalic truncus at PET-CT imaging.

Keywords:

FDG PET-CT, Fever of unknown origin, FUO Takayasu arteritis, Vasculitis,

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Arnaud, L., Haroche, J., Malek, Z., Archambaud, F., Gambotti, L., Grimon, G., Kas, A., Costedoat-Chalumeau, N., Cacoub, P., Toledano, D., Cluzel, P., Piette, J.C., Amoura, Z., 2009. (18)F-fluorodeoxyglucose positron emission tomography scanning a reliable way to assess disease activity in Takayasu arteritis?. Arthritis Rheum 2009.60,1193-200.
Belhocine, T., Blockmans, D., Hustinx, R., Vandevivere, J., Mortelmans, L., 2003. Imaging of large vessel vasculitis with 18FDG PET: illusion or reality? A critical review of the literature data. Eur J Nucl Med Mol Imaging. 30(9),1305-1313.
Chrapko, BE., Chrapko, M., Nocun, A., Stefaniak, B., Zubilewicz, T., Drop, A., 2016. Role of 18F-FDG PET/CT in the diagnosis of inflammatory and infectious vascular disease. Nucl Med Rev Cent East Eur. 19,28-36.
Hellmich, B., Agueda, A., Monti, S., Buttgereit, F., Boysson, H., Brouwer, E., Cassie, R., Cid, M.C., Dasgupta, B., Dejaco, C., Hatemi, G., Hollinger, N., Mahr, A., Mollan, S.P., Mukhtyar, C., Ponte, C., Salvarani, C., Sivakumar, R., Tian, X., Tomasson, G., Turesson, C., Schmidt, W., Villiger, P.M., Watts, R., Young, C., Luqmani, R.A., 2009. EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 68,318-323.
Kobayashi, Y., Ishii, K., Oda, K., Nariai, T., Tanaka, Y., Ishiwata, K., Numano, F., 2005. Aortic wall inflammation due to Takayasu arteritis imaged with 18F-FDG PET coregistered with enhanced CT. J Nucl Med. 46,917-922.
Pelletier-Galarneau, M., Ruddy, T.D., 2019. PET/CT for Diagnosis and Management of Large-Vessel Vasculitis. Curr Cardiol Rep. 21(5),34. doi: 10.1007/s11886-019-1122-z.
Schreiber, B.E., Tam, H.H.C., Carvalho, C., Wong, W.L., Russell, A.I., Higgens, C.S., 2009. F-18 PET-CT showing large vessel vasculitis in a patient with high inflammatory markers and no localizing symptoms. Clin Nucl Med. 34(11),785-787.
Seyahi, E., 2017. Takayasu arteritis: an update. Curr Opin Rheumatol. 29(1),51-56.
Turlakow, A., Yeung, HW., Pui, J., Macapinlac, H., Liebovitz, E., Rusch, V., Goy, A., Larson, S.M., 2001. Fluodeoxyglucose positron emission tomography in the diagnosis of giant cell arteritis. Arch Intern Med. 161,1003-1007.
Webb, M., Chambers, A., AL-Nahhas, A., Mason, J.C., Maudlin, L., Rahman, L., Frank, J., 2004. The role of 18F-FDG PET in characterising disease activity in Takayasu arteritis. Eur J Nucl Med Mol Imaging. 31,627-634.
Vaidyanathan, S., Patel, C.N., Scarsbrook, A.F., Chowdhury, F.U., 2015. FDG PET/CT in infection and inflammation—current and emerging clinical applications. Clin Radiol. 70,787-800.