CASE REPORT   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2019 September;178(9):706-10

DOI: 10.23736/S0393-3660.18.03933-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

A strange case of fever and polyarthralgia in patient with fibromyalgia syndrome: a case report of large vessel vasculitis

Guerino RECINELLA ✉, Giordano GIANOTTI, Giampaolo BIANCHI

Division of Internal Medicine, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy

Large vessels vasculitis a heterogeneous group of chronic inflammation disorders affecting the aorta and its main branches. The two main forms are Takayasu’s arteritis and Giant Cell arteritis. In recent years, this distinction does not seem so obvious due to many overlapping in pathogenesis, clinical and therapeutic management. We present a case of large vessel vasculitis in a 57-year-old woman with hypertension and long history of fibromyalgia syndrome. She was referred to our Unit for fever and polyarthralgia. The microbiological examinations performed were all negative, and the autoantibody pattern was also negative. Abdominal computer tomography showed abdominal aortic thickening with progressive contrast enhancement. Fluorodeoxyglucose positron emission tomography showed significant hypermetabolism of common carotid arteries, succlavie, aortic arch and abdominal aorta. It was treated with a methylprednisolone 1 mg/kg body weight for 7 days with remission of symptoms. Fluorodeoxyglucose positron emission tomography was repeated after 3 months of low dose steroid therapy and has shown a reduction in the capture of fluorodeoxyglucose. Our case highlights the importance of good collection of clinical history and imaging in the diagnosis of large vessel vasculitis. In particular fluorodeoxyglucose positron emission tomography is useful for diagnosis and to evaluate the response to therapy. A long history of fibromyalgia should not exclude suspect of these conditions.

KEY WORDS: Vasculitis; Fever of unknown origin; Fibromyalgia