Extra-cranial Giant Cell Arteritis: A Diagnostic Challenge Authors:

by guest on February 5, 2015 D ow nloaded from Case 1 A 61-year-old female was referred to our clinic with a 6 week history of fatigue, weight loss and fevers. She also reported epigastric and bilateral buttock pain. She had no medical history and took no medication. Examination revealed epigastric and left groin tenderness without peritonism. Peripheral pulses were intact. Temporal arteries were non-tender and the remaining examination was normal. Initial blood tests revealed a normocytic anaemia (Hb 9.1 g/dL), WCC 7.5 x 10/L and Plts 331 x 10/L. Inflammatory markers were elevated: ESR 103 mm/hr and CRP 118 mg/L and ALP was raised at 418 U/L; other LFTs and renal function were normal. Autoimmune serology, serial sets of blood cultures and urinalysis were all negative. CT scan of the chest, abdomen and pelvis (CT CAP) was unremarkable; however subsequent PET-CT scan demonstrated an extensive aortitis (Figure 1a) consistent with large vessel vasculitis and a diagnosis of Giant Cell Arteritis (GCA) was made. She was treated with 60mg prednisolone once daily and methotrexate 15mg once weekly. Symptoms improved after 3 days with normalisation of CRP by week four