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

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 (amaur...

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Autores principales: McCausland, Beth, Desai, David, Havard, David, Kaur, Yasmin, Yener, Asalet, Bradley, Emma, Patel, Harnish P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319224/
https://www.ncbi.nlm.nih.gov/pubmed/31011074
http://dx.doi.org/10.3390/geriatrics3030036
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author McCausland, Beth
Desai, David
Havard, David
Kaur, Yasmin
Yener, Asalet
Bradley, Emma
Patel, Harnish P.
author_facet McCausland, Beth
Desai, David
Havard, David
Kaur, Yasmin
Yener, Asalet
Bradley, Emma
Patel, Harnish P.
author_sort McCausland, Beth
collection PubMed
description 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.
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spelling pubmed-63192242019-03-07 A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA) McCausland, Beth Desai, David Havard, David Kaur, Yasmin Yener, Asalet Bradley, Emma Patel, Harnish P. Geriatrics (Basel) Case Report 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. MDPI 2018-06-29 /pmc/articles/PMC6319224/ /pubmed/31011074 http://dx.doi.org/10.3390/geriatrics3030036 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
McCausland, Beth
Desai, David
Havard, David
Kaur, Yasmin
Yener, Asalet
Bradley, Emma
Patel, Harnish P.
A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA)
title A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA)
title_full A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA)
title_fullStr A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA)
title_full_unstemmed A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA)
title_short A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA)
title_sort stab in the dark: a case report of an atypical presentation of giant cell arteritis (gca)
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319224/
https://www.ncbi.nlm.nih.gov/pubmed/31011074
http://dx.doi.org/10.3390/geriatrics3030036
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