Published online Feb 6, 2023. doi: 10.12998/wjcc.v11.i4.918
Peer-review started: September 27, 2022
First decision: December 13, 2022
Revised: December 13, 2022
Accepted: January 12, 2023
Article in press: January 12, 2023
Published online: February 6, 2023
Processing time: 131 Days and 19.4 Hours
Although fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is widely used for diagnosis and follow-up of large sized vessel vasculitis, it is still not widely used for small to medium sized vessel vasculitis.
This is the case of a 68-year-old male who presented at the emergency department complaining of fever, myalgia, and bilateral leg pain of over two weeks duration, with elevated levels of C-reactive protein. He was subsequently admitted and despite the absence of clinically significant findings, the patient continued to exhibit recurrent fever. A fever of unknown origin workup, which included imaging studies using FDG-PET/CT, revealed vasculitis involving small to medium-sized vessels of both lower extremities, demonstrated by linear hypermetabolism throughout the leg muscles. The patient was treated with methylprednisolone and methotrexate after diagnosis leading to the gradual resolution of the patient’s symptoms. Three weeks later, a follow-up FDG-PET/CT was performed. Previously hypermetabolic vessels were markedly improved.
Our case report demonstrated that FDG-PET/CT has tremendous potential to detect medium-sized vessel inflammation; it can also play a crucial role in prognosticating outcomes and monitoring therapeutic efficacy.
Core Tip: The fluorodeoxyglucose-positron emission tomography/computed tomography can be an option to diagnose small to medium-sized vessel vasculitis and follow-up to assess on the extent and improvement of inflammation in patients with polyarteritis nodosa.