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PICTURES IN CLINICAL MEDICINE
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Polyarteritis Nodosa Mimicking Giant Cell (Temporal) Arteritis Kenichiro Yaita 1, Kazuhiko Nakaharai 1, Yukihiro Yoshimura 1 and Motoharu Hirano 2 Key words: polyarteritis nodosa, giant cell arteritis, fever of unknown origin (Intern Med 53: 1591-1592, 2014) (DOI: 10.2169/internalmedicine.53.2533)
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A 62-year-old man was hospitalized due to a fever (>38°C) that had persisted for two weeks in addition to body weight loss (-15 kg). His laboratory data showed a high level of inflammation (white blood cell count: 31,500/ μL (neutrophils: 95%), c-reactive protein: 22.4 mg/dL).
Based on his symptoms, including tenderness of a thickened left superficial temporal artery (Picture 1, arrow) and the bilateral thighs, we suspected a diagnosis of giant cell arteritis (GCA) with polymyalgia rheumatica. However, a biopsy of the temporal artery revealed non-giant cell arteritis with neutrophilic granulocytes in the artery wall (Picture 2). In addition, the presence of multiple intrahepatic and intrapancreatic aneurysms confirmed on contrast-enhanced computed tomography (Picture 3, arrows) was compatible with the features of polyarteritis nodosa. We initiated treatment with steroid pulse therapy (methylprednisolone: 1,000 mg intravenously for three days) followed by oral methylprednisolone (48 mg daily), and the patient’s symptoms improved immediately. Clinicians should therefore consider the possibility of other vasculitis syndromes besides GCA in patients presenting with inflammation of the temporal artery (1, 2). The authors state that they have no Conflict of Interest (COI).
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Department of Infectious Diseases, Yokohama Municipal Citizen’s Hospital, Japan and ２Department of Diabetes Mellitus and Rheumatology, Yokohama Municipal Citizen’s Hospital, Japan Received for publication January 21, 2014; Accepted for publication February 18, 2014 Correspondence to Dr. Kenichiro Yaita,
[email protected]
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Intern Med 53: 1591-1592, 2014
DOI: 10.2169/internalmedicine.53.2533
References 1. Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides.
Arthritis Rheum 65: 1-11, 2013. 2. Haugeberg G, Bie R, Johnsen V. Vasculitic changes in the temporal artery in polyarteritis nodosa. Scand J Rheumatol 26: 383-385, 1997.
Ⓒ 2014 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
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