Identify Large Vessel Vasculitis in Patient with Fever of Unknown Origin (FUO)

 

Patient selection: fever of unknown origin, following complete initial evaluation

 

Reasons to suspect a large vessel vasculitis:

(1) elevation in C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR)

(2) claudication

(3) myalgias

(4) new onset of headache or scalp pain in someone > 50 years old

Diagnostic Steps	Followup
duplex US of occipital, cranial, subclavian and cervical arteries	biopsy artery if possible
age > 50	biopsy branch of temporal artery
MRI of aortic arch
FDG-PET scan

 

Initiate therapy if

(1) a biopsy confirms the diagnosis of large vessel vasculitis.

(2) MRI or PET scan is diagnostic for large vessel vasculitis

 

If all results are negative then consider another diagnosis.