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Open AccessCase Report

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

1
Medicine for Older People, University Hospital Southampton, Southampton SO16 6YD, UK
2
Academic Geriatric Medicine, University of Southampton, University Hospital, Southampton SO16 6YD, UK
3
NIHR Biomedical Research Centre Southampton, University of Southampton, Southampton SO16 6YD, UK
*
Author to whom correspondence should be addressed.
Joint first authors.
Geriatrics 2018, 3(3), 36; https://doi.org/10.3390/geriatrics3030036
Received: 31 May 2018 / Revised: 25 June 2018 / Accepted: 27 June 2018 / Published: 29 June 2018
(This article belongs to the Section Geriatric Rheumatology)
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PDF [1383 KB, uploaded 29 June 2018]
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Abstract

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

McCausland, B.; Desai, D.; Havard, D.; Kaur, Y.; Yener, A.; Bradley, E.; Patel, H.P. A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA). Geriatrics 2018, 3, 36.

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