A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA)

摘要: Background: Giant cell arteritis/temporal arteritis (GCA) is an inflammatory condition that affects large to medium vessels such as the aorta and its primary branches. Patients classically present with fatigue, fever, headache, jaw claudication in severe cases, may suffer either transient (amaurosis fugax) or permanent visual loss. The reference standard for diagnosis temporal artery biopsy (TAB) mainstay of treatment immunosuppression. Our patient JG, presented a range non-specific symptoms mimicked generalised sepsis, but was ultimately diagnosed GCA through effective, methodical multi-disciplinary team (MDT) work. Clinical case: 81 year old gentleman, acutely 3–4 weeks history lethargy, pyrexia marked response suggestive sepsis without clear source clinical features vasculitis. His markers were markedly raised although his erythrocyte sedimentation rate (ESR) not elevated. He initially treated unknown origin however, body imaging after admission suggested possible infection around previous aortic graft site. This refuted subsequent 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET/CT) scanning. Microbiological, parasitic, well autoimmune assays unremarkable. underwent TAB which diagnostic result, started on oral corticosteroids immediate symptom relief. discharged followed up outpatient basis. Conclusions: case highlights how vasculitis can resemble fever (FUO)/sepsis lead delay making correct diagnosis. It also importance considering patients who FUO where there no focus infection. Delays management these conditions potentially significant irreversible morbidity.